Individual provider · NPI-1

Jorge L Acosta, IDC

Military Health Care Provider, Independent Duty Corpsman · San Diego, CA

NPI number1649576828
StatusActive
Last updated in NPPESJul 28, 2021

Details

NPI
1649576828
Entity type
Individual (NPI-1)
Name
Mr. Jorge L Acosta
Credential
IDC
Sex
Male
Sole proprietor
Yes
Enumeration date
Feb 4, 2011
Certification date
Jul 28, 2021
Last updated
Jul 28, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1710I1002X Military Health Care Provider, Independent Duty Corpsman––Yes

Practice location

34101 Farenholt Ave Ste 233
San Diego, CA 92134-7000

Phone 619-548-3754

Mailing address

34101 Farenholt Ave Ste 233
San Diego, CA 92134-7000

Phone 619-548-3754

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