Provider Demographics
NPI:1033697107
Name:RODRIGUEZ ACOSTA, EMILIO JOSE
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:JOSE
Last Name:RODRIGUEZ ACOSTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11620 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-2915
Mailing Address - Country:US
Mailing Address - Phone:754-610-4024
Mailing Address - Fax:
Practice Address - Street 1:11620 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-2915
Practice Address - Country:US
Practice Address - Phone:754-610-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23713122300000X
VA0401416239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist