MEDICARE: DR. LETICIA 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	DN19441	FL

General Provider Information

NPI Number	:	1467740381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LETICIA ACOSTA

Provider Business Mailing Address
First Line	:	2335 CORAL POINT DR
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3812
Country	:	US
Telephone Number	:	239-699-6602
Fax Number	:

Provider Business Practice Location Address
First Line	:	10484 STRINGFELLOW RD
Second Line	:	SUITE 3
City	:	ST JAMES CITY
State	:	FL
Zip	:	33956-3208
Country	:	US
Telephone Number	:	239-283-1041
Fax Number	:	239-283-1684

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

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	07/12/2011

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Directions to “ DR. LETICIA ACOSTA ” Practice Location

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