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Individual

BLANCA-IBETH ACOSTA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
15305 RAYEN ST, NORTH HILLS, CA 91343-5117
(818) 892-3423
Mailing address
15305 RAYEN ST, NORTH HILLS, CA 91343-5117
(818) 892-3423

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
95-2633765
CA
Enumeration date
07/05/2017
Last updated
08/16/2017
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