Healthcare Provider Details

I. General information

NPI: 1386601854
Provider Name (Legal Business Name): JOSE IGNACIO ACOSTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4888 NW 183RD ST SUITE 101
MIAMI GARDENS FL
33055-2900
US

IV. Provider business mailing address

14255 SW 20TH TER
MIAMI FL
33175-7070
US

V. Phone/Fax

Practice location:
  • Phone: 305-685-5688
  • Fax: 305-688-7995
Mailing address:
  • Phone: 305-551-5877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME81117
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: