Provider Demographics
NPI:1023752649
Name:RUBAYO-ACOSTA, MELBA L
Entity type:Individual
Prefix:
First Name:MELBA
Middle Name:L
Last Name:RUBAYO-ACOSTA
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 1:12401 SW 187TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3129
Mailing Address - Country:US
Mailing Address - Phone:786-252-0037
Mailing Address - Fax:305-316-3002
Practice Address - Street 1:1738 W 49TH ST STE 10
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3457
Practice Address - Country:US
Practice Address - Phone:305-698-8432
Practice Address - Fax:305-698-8975
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily