Provider Demographics
NPI:1497039655
Name:NOSTRUM MEDICAL CENTER HOMESTEAD LLC
Entity Type:Organization
Organization Name:NOSTRUM MEDICAL CENTER HOMESTEAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NILDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-242-5336
Mailing Address - Street 1:1235 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4204
Mailing Address - Country:US
Mailing Address - Phone:305-242-5336
Mailing Address - Fax:305-242-5337
Practice Address - Street 1:1235 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4204
Practice Address - Country:US
Practice Address - Phone:305-242-5336
Practice Address - Fax:305-242-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty