Provider Demographics
NPI:1871066308
Name:ACOSTA, WILLIAM GUY JR (LAC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GUY
Last Name:ACOSTA
Suffix:JR
Gender:M
Credentials:LAC
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Mailing Address - Street 1:140 W CASTELLANO DR UNIT 436
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6309
Mailing Address - Country:US
Mailing Address - Phone:915-208-3037
Mailing Address - Fax:
Practice Address - Street 1:1700 CURIE DR STE 2400
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2905
Practice Address - Country:US
Practice Address - Phone:915-208-3037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01853171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist