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General NPI Number Information
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NPI Number | 1184344756
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Entity Type | Individual
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Provider Name | GRACE ACOSTA PA
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Gender | Female
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 1420 LOCUST ST
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4223
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Country | US
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Telephone | 215-800-1909
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Fax |
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Provider Business Mailing Address
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Address Line | 220 S 47TH ST APT 238
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City | PHILADELPHIA
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State | PA
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Zip | 19139-4485
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Country | US
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Telephone | 267-994-4257
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA063870
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License Number State | PA
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