Provider Demographics
NPI:1366431819
Name:ACOSTA RIVERA, ALEJANDRO (MD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:
Last Name:ACOSTA RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 869
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO, PR
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00623
Mailing Address - Country:UM
Mailing Address - Phone:787-892-4430
Mailing Address - Fax:787-892-0083
Practice Address - Street 1:CALLE LUNA ESQUINA SALUD #139
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-4430
Practice Address - Fax:787-892-0083
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8754207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29393Medicare ID - Type Unspecified
PRD08510Medicare UPIN