Provider Demographics
NPI:1396095337
Name:ACOSTA, GONZALO J
Entity type:Individual
Prefix:
First Name:GONZALO
Middle Name:J
Last Name:ACOSTA
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:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95038-0546
Mailing Address - Country:US
Mailing Address - Phone:408-776-6201
Mailing Address - Fax:408-778-9672
Practice Address - Street 1:6980 CHURCH ST.
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020
Practice Address - Country:US
Practice Address - Phone:408-776-6201
Practice Address - Fax:408-778-9672
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker