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General NPI Number Information
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NPI Number | 1649474800
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Entity Type | Organization
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Legal Business Name | I. ACOSTA, M.D., INC.
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 1808 VERDUGO BLVD SUITE 409
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City | GLENDALE
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State | CA
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Zip | 91208-1477
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Country | US
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Telephone | 818-790-8020
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Fax | 818-790-9313
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Provider Business Mailing Address
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Address Line | 1808 VERDUGO BLVD SUITE 409
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City | GLENDALE
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State | CA
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Zip | 91208-1477
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Country | US
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Telephone | 818-790-8020
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Fax | 818-790-9313
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | IGNACIO ACOSTA
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Credential | MD
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Telephone | 818-790-8020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A26640
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License Number State | CA
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