1013164912 NPI number — OSCAR MARIO ACOSTA DDS

Table of content: OSCAR MARIO ACOSTA DDS (NPI 1013164912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013164912 NPI number — OSCAR MARIO ACOSTA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACOSTA
Provider First Name:
OSCAR
Provider Middle Name:
MARIO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013164912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 961629
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-591-1709
Provider Business Mailing Address Fax Number:
915-591-1709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AV AMERICAS #388
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAUREZ
Provider Business Practice Location Address State Name:
CHIH
Provider Business Practice Location Address Postal Code:
32310
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
011526566117551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  1257436 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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