MEDICARE: MS. SUSAN 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	174400000X	Specialist

General Provider Information

NPI Number	:	1922277896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN ACOSTA

Provider Business Mailing Address
First Line	:	9150 IMPERIAL HWY
Second Line	:	ROOM P-31
City	:	DOWNEY
State	:	CA
Zip	:	90242-2835
Country	:	US
Telephone Number	:	562-940-3694
Fax Number	:	562-658-4725

Provider Business Practice Location Address
First Line	:	11234 VALLEY BLVD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-3241
Country	:	US
Telephone Number	:	626-575-4233
Fax Number	:	626-459-4030

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

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	02/26/2008

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