Healthcare Provider Details

I. General information

NPI: 1235140997
Provider Name (Legal Business Name): LUIS D ACOSTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/20/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 ALBERTA AVE
EL PASO TX
79905-2707
US

IV. Provider business mailing address

5130 GATEWAY BLVD EAST C.P. MSC 51015
EL PASO TX
79905
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-5900
  • Fax: 915-215-5969
Mailing address:
  • Phone: 915-215-4479
  • Fax: 915-215-5386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberJ3713
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberJ3713
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: