Provider Demographics
NPI:1962835348
Name:ACOSTA, RANESSA LAUREN
Entity type:Individual
Prefix:
First Name:RANESSA
Middle Name:LAUREN
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RANESSA
Other - Middle Name:LAUREN
Other - Last Name:ACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4808
Mailing Address - Country:US
Mailing Address - Phone:530-251-8108
Mailing Address - Fax:530-251-8394
Practice Address - Street 1:555 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4808
Practice Address - Country:US
Practice Address - Phone:530-251-8108
Practice Address - Fax:530-251-8394
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner