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General NPI Number Information
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NPI Number | 1164793873
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Entity Type | Individual
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Provider Name | RAFAEL DIAZ ACOSTA MD
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Gender | Male
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Dates
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Enumeration Date | 01/26/2012
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 3499 W 4TH AVE STE 201
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City | HIALEAH
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State | FL
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Zip | 33012-4333
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Country | US
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Telephone | 305-558-0411
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Fax |
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Provider Business Mailing Address
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Address Line | 10081 PINES BLVD STE B
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6171
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Country | US
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Telephone | 954-251-1175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | BP20039782
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME129046
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License Number State | FL
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