Provider Demographics
NPI:1154771814
Name:ACOSTA, IVONNE
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name: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 1:17321 SW 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2210
Mailing Address - Country:US
Mailing Address - Phone:786-282-0144
Mailing Address - Fax:
Practice Address - Street 1:5301 SW 77TH CT
Practice Address - Street 2:APT. 204G
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4392
Practice Address - Country:US
Practice Address - Phone:786-282-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator