Provider Demographics
NPI:1043678485
Name:ACOSTA VALDES, ISABEL MARIA
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:MARIA
Last Name:ACOSTA VALDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 SW 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1233
Mailing Address - Country:US
Mailing Address - Phone:305-263-0107
Mailing Address - Fax:
Practice Address - Street 1:1619 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4603
Practice Address - Country:US
Practice Address - Phone:305-247-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-30
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN229581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty