Provider Demographics
NPI:1083861439
Name:ACOSTA, MAYRA (MD)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 S MIAMI AVE STE 801
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4223
Mailing Address - Country:US
Mailing Address - Phone:305-860-6260
Mailing Address - Fax:305-860-6590
Practice Address - Street 1:3661 S MIAMI AVE STE 801
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4223
Practice Address - Country:US
Practice Address - Phone:305-860-6260
Practice Address - Fax:305-860-6590
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL107229207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GF836ZMedicare UPIN