Provider Demographics
NPI:1588438758
Name:ACOSTA, JACQUELINE GUADALUPE (RD, LD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:GUADALUPE
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 GLYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4418
Mailing Address - Country:US
Mailing Address - Phone:956-443-5289
Mailing Address - Fax:
Practice Address - Street 1:1001 RONE DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4843
Practice Address - Country:US
Practice Address - Phone:956-600-3475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1201X
TXDT89122133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management