1932145513 NPI number — IGNACIO ACOSTA M.D.

Table of content: IGNACIO ACOSTA M.D. (NPI 1932145513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932145513 NPI number — IGNACIO ACOSTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACOSTA
Provider First Name:
IGNACIO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1932145513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1808 VERDUGO BLVD
Provider Second Line Business Mailing Address:
SUITE 409
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91208-1477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-790-8020
Provider Business Mailing Address Fax Number:
818-790-9313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1808 VERDUGO BLVD
Provider Second Line Business Practice Location Address:
SUITE 409
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91208-1487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-790-8020
Provider Business Practice Location Address Fax Number:
818-790-9313
Provider Enumeration Date:
06/21/2006

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: 208600000X , with the licence number:  A26640 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0004033429 . This is a "AETNA ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020011428 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 000767453 . This is a "APWU ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00A266400 . This is a "BLUE SHIELD ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300000306091 . This is a "PLAN HANDLERS ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 953131650 . This is a "BLUE CROSS ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00A266401 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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