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General NPI Number Information
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NPI Number | 1437424983
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Entity Type | Individual
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Provider Name | PABLO C ACOSTA NP
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Gender | Male
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 16113 W CORONADO RD
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City | GOODYEAR
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State | AZ
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Zip | 85395-7130
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Country | US
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Telephone | 623-695-0449
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Fax |
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Provider Business Mailing Address
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Address Line | 161 E RIVULON BLVD STE 210
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City | GILBERT
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State | AZ
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Zip | 85297-0087
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Country | US
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Telephone | 480-494-2465
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Fax | 480-534-4087
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP7817
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN110209
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License Number State | AZ
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