Healthcare Provider Details

I. General information

NPI: 1790260362
Provider Name (Legal Business Name): MARCELA ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2018
Last Update Date: 09/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9514 CONSOLE DR
SAN ANTONIO TX
78229-2069
US

IV. Provider business mailing address

11559 WOOD HBR
SAN ANTONIO TX
78249-1930
US

V. Phone/Fax

Practice location:
  • Phone: 210-448-9111
  • Fax:
Mailing address:
  • Phone: 956-624-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number33362
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: