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General NPI Number Information
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NPI Number | 1841477114
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Entity Type | Organization
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Legal Business Name | IDALIA A ACOSTA MDPA
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 06/25/2009
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Provider Practice Location Address
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Address Line | 8260 W FLAGLER ST STE 2K
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City | MIAMI
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State | FL
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Zip | 33144-2069
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Country | US
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Telephone | 305-220-1020
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Fax | 305-220-0906
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Provider Business Mailing Address
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Address Line | 8260 W FLAGLER ST STE 2K
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City | MIAMI
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State | FL
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Zip | 33144-2069
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Country | US
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Telephone | 305-220-1020
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Fax | 305-220-0906
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Authorized Official
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Title or Position | PRESIDENT
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Name | IDALIA A ACOSTA
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Credential | M.D.
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Telephone | 305-220-1020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME0066961
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License Number State | FL
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