Healthcare Provider Details

I. General information

NPI: 1881286169
Provider Name (Legal Business Name): JOSUE ACOSTA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 MADRID DR
CHAPARRAL NM
88081-7670
US

IV. Provider business mailing address

841 MADRID DR
CHAPARRAL NM
88081-7670
US

V. Phone/Fax

Practice location:
  • Phone: 915-270-3085
  • Fax:
Mailing address:
  • Phone: 915-270-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60679
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: