Provider Demographics
NPI:1558334524
Name:ACOSTA-RODRIGUEZ, OSVALDO (MD)
Entity type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:ACOSTA-RODRIGUEZ
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 1:1500 SOUTHWEST BLVD
Mailing Address - Street 2:STE C CAPITAL REGION CORPORATE HEALTH CLINIC
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109
Mailing Address - Country:US
Mailing Address - Phone:573-632-5786
Mailing Address - Fax:573-632-5833
Practice Address - Street 1:1500 SOUTHWEST BLVD
Practice Address - Street 2:STE C
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109
Practice Address - Country:US
Practice Address - Phone:573-632-5786
Practice Address - Fax:573-632-5833
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003026609208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00085648OtherRR MEDICARE
0549741OtherCIGNA
1178759OtherFIRST HEALTH
G17884OtherMERCY
187895OtherBLUE CROSS BLUE SHIELD
627300OtherHEALTHLINK
CD9211OtherRR MEDICARE
CD9211OtherRR MEDICARE