Provider Demographics
NPI:1417479288
Name:ACOSTAMADIEDO, JENNIFER (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:ACOSTAMADIEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 DOMINICAN WAY STE 222
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1515
Mailing Address - Country:US
Mailing Address - Phone:844-387-5337
Mailing Address - Fax:866-264-3890
Practice Address - Street 1:1665 DOMINICAN WAY STE 222
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1515
Practice Address - Country:US
Practice Address - Phone:844-387-5337
Practice Address - Fax:866-264-3890
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA170693207RS0012X, 207RP1001X
IL125071547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease