MEDICARE: JOLETTE GUADALUPE ACOSTA

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
1	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1245195452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOLETTE GUADALUPE ACOSTA

Provider Business Mailing Address
First Line	:	996 ROYAL MARCO WAY
Second Line	:
City	:	MARCO ISLAND
State	:	FL
Zip	:	34145-1829
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5959 TOPANGA CANYON BLVD STE 125
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7598
Country	:	US
Telephone Number	:	747-356-4185
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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