Provider Demographics
NPI:1154170124
Name:ACOSTA VARGAS, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ACOSTA VARGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 CALLE 30 BO CELADA PN
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-2924
Mailing Address - Country:US
Mailing Address - Phone:787-688-0966
Mailing Address - Fax:
Practice Address - Street 1:367 CALLE 30
Practice Address - Street 2:BO CELADA PARCELAS NUEVAS
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2924
Practice Address - Country:US
Practice Address - Phone:787-688-0966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR016215183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician