=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144273459
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ONNIS ACOSTA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 10/31/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 AVE HIPODROMO
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00909-2534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-721-5964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | COND ESTANCIAS CHALETS 193 TORTOSA APT. 28
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-2371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-359-6637
-----------------------------------------------------
Fax | 180-050-8064
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 14941
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------