MEDICARE: ROXANA ALVAREZ ACOSTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30469	FL

General Provider Information

NPI Number	:	1043109762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANA ALVAREZ ACOSTA

Provider Business Mailing Address
First Line	:	10101 W OKEECHOBEE RD APT 10-201
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17776 NW 57TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5118
Country	:	US
Telephone Number	:	786-579-1206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	06/30/2025

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