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General NPI Number Information
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NPI Number | 1760910962
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Entity Type | Organization
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Legal Business Name | ACOSTA AND CABRERA MEDICAL ASSOCIATES, S.C.
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3100 OAK PARK AVE STE 1S
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City | BERWYN
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State | IL
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Zip | 60402-4177
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Country | US
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Telephone | 708-317-4422
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Fax | 708-317-4428
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Provider Business Mailing Address
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Address Line | 3100 S. OAK PARK AVE STE 1 SOUTH
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City | BERWYN
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State | IL
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Zip | 60402
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Country | US
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Telephone | 708-317-4422
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Fax | 708-317-4428
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YANET ACOSTA
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Credential | MD
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Telephone | 630-240-8808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036135636
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License Number State | IL
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