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General NPI Number Information
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NPI Number | 1417479288
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Entity Type | Individual
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Provider Name | JENNIFER ACOSTAMADIEDO MD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1665 DOMINICAN WAY STE 222
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1515
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Country | US
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Telephone | 844-387-5337
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Fax | 866-264-3890
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Provider Business Mailing Address
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Address Line | 1665 DOMINICAN WAY STE 222
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1515
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Country | US
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Telephone | 844-387-5337
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Fax | 866-264-3890
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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 | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | A170693
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125071547
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A170693
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License Number State | CA
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