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General NPI Number Information
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NPI Number | 1194895045
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Entity Type | Individual
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Provider Name | HERIBERTO A ACOSTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 255 CALLE MANUEL DOMENECH
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City | SAN JUAN
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State | PR
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Zip | 00918-3510
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Country | US
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Telephone | 787-753-0255
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Fax | 787-753-5082
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Provider Business Mailing Address
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Address Line | AVE. DOMENECH #255
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City | SAN JUAN
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State | PR
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Zip | 00918-1535
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Country | US
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Telephone | 787-753-0255
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Fax | 787-753-5082
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 5620
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License Number State | PR
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