Provider Demographics
NPI:1861418618
Name:ACOSTA, JOSE ALFREDO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALFREDO
Last Name:ACOSTA
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 1:4249 WITHERBY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:NAVAL MEDICAL CENTER SAN DIEGO DEPARTMENT OF SURGERY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-532-7579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0093182086S0102X
CAG789662086S0127X
NM87-3752086S0127X
DCMD303092086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Not Answered2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery