Healthcare Provider Details

I. General information

NPI: 1528030236
Provider Name (Legal Business Name): HUMBERTO ACOSTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 09/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALLE MACEO
CABO ROJO PR
00623-3509
US

IV. Provider business mailing address

195 CALLE PICAFLOR QUINTAS DE CABO ROJO
CABO ROJO PR
00623-4229
US

V. Phone/Fax

Practice location:
  • Phone: 787-851-1400
  • Fax: 787-255-4125
Mailing address:
  • Phone: 787-851-1400
  • Fax: 787-255-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10708
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: