Healthcare Provider Details

I. General information

NPI: 1952456477
Provider Name (Legal Business Name): GILBERTO JOSE ACOSTA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
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 Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO 2800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: