Healthcare Provider Details

I. General information

NPI: 1891781332
Provider Name (Legal Business Name): GILBERTO J ACOSTA PODIATRIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 E 49TH ST
HIALEAH FL
33013-1963
US

IV. Provider business mailing address

613 E 49TH ST
HIALEAH FL
33013-1963
US

V. Phone/Fax

Practice location:
  • Phone: 305-828-2288
  • Fax: 305-828-2399
Mailing address:
  • Phone: 305-828-2288
  • Fax: 305-828-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO 2800
License Number StateFL

VIII. Authorized Official

Name: MR. GILBERTO J ACOSTA
Title or Position: PRESIDENT
Credential: DPM
Phone: 305-828-2288