Provider Demographics
NPI:1285738716
Name:ACOSTA, IDALIA A (MD)
Entity type:Individual
Prefix:
First Name:IDALIA
Middle Name:A
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 W FLAGLER ST
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0066961208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0066961OtherMEDICAL LICENSE NUMBER
FL25992OtherBCBS PROV NUMBER
FL375698000Medicaid
FL375698000Medicaid
FL25992Medicare PIN