Provider Demographics
NPI:1427670025
Name:ACOSTA DE GONZALEZ, MARIA ISABEL
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ISABEL
Last Name:ACOSTA DE GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ISABEL
Other - Last Name:ACOSTA TORREALBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:26520 CACTUS AVE STE B2020
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3927
Mailing Address - Country:US
Mailing Address - Phone:951-486-6400
Mailing Address - Fax:951-486-4545
Practice Address - Street 1:26520 CACTUS AVE STE B2020
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-6400
Practice Address - Fax:951-486-4545
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA189397207V00000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program