MEDICARE: RAFAEL DIAZ ACOSTA MD

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	208600000X	Surgery Physician	BP20039782	TX
2	208600000X	Surgery Physician	ME129046	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164793873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL DIAZ ACOSTA MD

Provider Business Mailing Address
First Line	:	10081 PINES BLVD STE B
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6171
Country	:	US
Telephone Number	:	954-251-1175
Fax Number	:

Provider Business Practice Location Address
First Line	:	3499 W 4TH AVE STE 201
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4333
Country	:	US
Telephone Number	:	305-558-0411
Fax Number	:

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

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	09/12/2024

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