Healthcare Provider Details

I. General information

NPI: 1023752649
Provider Name (Legal Business Name): MELBA L RUBAYO-ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 W 49TH ST STE 10
HIALEAH FL
33012-3457
US

IV. Provider business mailing address

12401 SW 187TH ST
MIAMI FL
33177-3129
US

V. Phone/Fax

Practice location:
  • Phone: 305-698-8432
  • Fax: 305-698-8975
Mailing address:
  • Phone: 786-252-0037
  • Fax: 305-316-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11018963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: