FANNY ACOSTA — OIG Excluded Provider (GLENDORA, CA, 1128b4)
FANNY ACOSTA — OIG Excluded Provider (GLENDORA, CA, 1128b4) is one of 9,000 exclusions in the ExcludeCheck dataset. Key details — Name: FANNY ACOSTA; Type: Individual; Provider category: THERAPIST.
| Name | FANNY ACOSTA |
|---|---|
| Type | Individual |
| Provider category | THERAPIST |
| City | GLENDORA |
| State | CA |
| ZIP | 91740 |
| Exclusion authority | 1128b4 |
| Exclusion reason | License revocation, suspension, or surrender |
| Exclusion date | 2002-11-20 |
| Source | HHS-OIG LEIE |
$1499/mo
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