Provider Demographics
NPI:1861743577
Name:ACOSTA-MARTINEZ, ADA N (MD)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:N
Last Name:ACOSTA-MARTINEZ
Suffix:
Gender:F
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:P.O. BOX 108
Mailing Address - Street 2:
Mailing Address - City:BOGUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622
Mailing Address - Country:US
Mailing Address - Phone:787-457-9812
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 173.4
Practice Address - Street 2:TORRE MEDICA SAN VICENTE DE PAUL OFICINA 510
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-983-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine