Provider Demographics
NPI:1316519937
Name:ACOSTA MEDICAL LLC
Entity type:Organization
Organization Name:ACOSTA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-649-1737
Mailing Address - Street 1:2550 SAMARITAN DR STE 205
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1170
Mailing Address - Country:US
Mailing Address - Phone:575-649-1737
Mailing Address - Fax:
Practice Address - Street 1:2550 SAMARITAN DR STE 205
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1170
Practice Address - Country:US
Practice Address - Phone:575-649-1737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty