Healthcare Provider Details

I. General information

NPI: 1336976810
Provider Name (Legal Business Name): RR ACOSTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8748 SW 8TH ST
MIAMI FL
33174-3201
US

IV. Provider business mailing address

10500 SW 108TH AVE APT B207
MIAMI FL
33176-8603
US

V. Phone/Fax

Practice location:
  • Phone: 786-665-6567
  • Fax: 540-304-2393
Mailing address:
  • Phone: 786-307-9365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: REYNALDO RUEDA ACOSTA
Title or Position: NP
Credential: APRN
Phone: 786-665-6567