Provider Demographics
NPI:1841477114
Name:IDALIA A ACOSTA MDPA
Entity type:Organization
Organization Name:IDALIA A ACOSTA MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-220-1020
Mailing Address - Street 1:8260 W FLAGLER ST
Mailing Address - Street 2:STE 2K
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2069
Mailing Address - Country:US
Mailing Address - Phone:305-220-1020
Mailing Address - Fax:305-220-0906
Practice Address - Street 1:8260 W FLAGLER ST
Practice Address - Street 2:STE 2K
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:305-220-1020
Practice Address - Fax:305-220-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066961208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375698000Medicaid
FL375698000Medicaid
FLAJ713Medicare PIN
FL25992Medicare PIN