Healthcare Provider Details

I. General information

NPI: 1891742151
Provider Name (Legal Business Name): ALMA I. ACOSTA LND
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 AGUAS CALIENTES ST. VENUS GARDENS
SAN JUAN PR
00926-4653
US

IV. Provider business mailing address

1688 CALLE AGUAS CALIENTES VENUS GARDENS
SAN JUAN PR
00926-4653
US

V. Phone/Fax

Practice location:
  • Phone: 787-469-6588
  • Fax: 787-755-2373
Mailing address:
  • Phone: 787-469-6588
  • Fax: 787-755-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1288
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: