Healthcare Provider Details

I. General information

NPI: 1619925690
Provider Name (Legal Business Name): ALEXIS ACOSTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CALLE SAN ANTONIO HORMIGUEROS PLAZA SUITE 4
HORMIGUEROS PR
00660-1708
US

IV. Provider business mailing address

PO BOX 1381
CABO ROJO PR
00623-1381
US

V. Phone/Fax

Practice location:
  • Phone: 787-849-0099
  • Fax: 787-849-0912
Mailing address:
  • Phone: 787-849-0099
  • Fax: 787-849-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16405
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: