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NPI Code Detail

MEDICARE: GONZALO ACOSTA SIERRA AMFT 143250

MEDICARE: GONZALO ACOSTA SIERRA AMFT 143250
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist
2390200000XStudent in an Organized Health Care Education/Training Program
3106H00000XMarriage & Family Therapist143250CA
4101Y00000XCounselor

General Provider Information

NPI Number : 1033662275
Entity Type Code : Individual
Provider Name (Legal Business Name) : GONZALO ACOSTA SIERRA AMFT 143250
Provider Business Mailing Address
First Line : 823 GATEWAY CENTER WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-4541
Country : US
Telephone Number : 619-515-2300
Fax Number :
Provider Business Practice Location Address
First Line : 2130 NATIONAL AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92113-2209
Country : US
Telephone Number : 619-255-5172
Fax Number : 619-269-0464
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2016
Last Update Date : 07/16/2024

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