Provider Demographics
NPI:1972891281
Name:ACOSTA, INMACULADA A (ITDS)
Entity Type:Individual
Prefix:MRS
First Name:INMACULADA
Middle Name:A
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 SW 63RD CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4709
Mailing Address - Country:US
Mailing Address - Phone:305-740-3347
Mailing Address - Fax:305-740-3347
Practice Address - Street 1:7040 SW 63RD CT
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4709
Practice Address - Country:US
Practice Address - Phone:305-740-3347
Practice Address - Fax:305-740-3347
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist