Organization
ACOSTA MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALENA A WILSON (ADMINISTRATOR)
(818) 240-0601
Entity
Organization
Contact information
Practice address
222 W EULALIA ST, STE. 201, GLENDALE, CA 91204-2849
(818) 240-0601
(818) 240-0687
Mailing address
222 W EULALIA ST, STE. 201, GLENDALE, CA 91204-2849
(818) 240-0601
(818) 240-0687
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G72214
CA
Other
Enumeration date
02/06/2008
Last updated
08/13/2009
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