Organization
I. ACOSTA, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IGNACIO ACOSTA MD (PRESIDENT OWNER)
(818) 790-8020
Entity
Organization
Contact information
Practice address
1808 VERDUGO BLVD, SUITE 409, GLENDALE, CA 91208-1477
(818) 790-8020
(818) 790-9313
Mailing address
1808 VERDUGO BLVD, SUITE 409, GLENDALE, CA 91208-1477
(818) 790-8020
(818) 790-9313
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A26640
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004033429
AETNA ID
CA
01
—
000767453
APWU ID
CA
01
—
00A266400
BLUE SHIELD ID
CA
05
—
00A266401
—
CA
01
—
300000306091
PLAN HANDLERS ID
CA
01
—
DO4784
RAILROAD MEDICARE PTAN
—
Enumeration date
06/12/2007
Last updated
05/04/2009
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