Provider Demographics
NPI:1104794023
Name:ACOSTA GOVIN, AITANA MARTHA
Entity type:Individual
Prefix:
First Name:AITANA
Middle Name:MARTHA
Last Name:ACOSTA GOVIN
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 1:3388 W 73RD TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1737
Mailing Address - Country:US
Mailing Address - Phone:786-355-4464
Mailing Address - Fax:
Practice Address - Street 1:7605 W 33RD CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5003
Practice Address - Country:US
Practice Address - Phone:305-557-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS69779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist