Provider Demographics
NPI:1144273459
Name:ACOSTA, ONNIS (MD)
Entity type:Individual
Prefix:DR
First Name:ONNIS
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND ESTANCIAS CHALETS
Mailing Address - Street 2:193 TORTOSA APT. 28
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2371
Mailing Address - Country:US
Mailing Address - Phone:787-359-6637
Mailing Address - Fax:180-050-8064
Practice Address - Street 1:800 AVE HIPODROMO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2534
Practice Address - Country:US
Practice Address - Phone:787-721-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14941208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH98265Medicare UPIN