Provider Demographics
NPI:1548343031
Name:ACOSTA-ALBINO, DOMINGO (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINGO
Middle Name:
Last Name:ACOSTA-ALBINO
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:PO BOX 7362
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-7362
Mailing Address - Country:US
Mailing Address - Phone:787-607-9940
Mailing Address - Fax:787-831-5440
Practice Address - Street 1:58 MEDITACION
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-831-5440
Practice Address - Fax:787-831-5440
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6671174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79491Medicare UPIN