Provider Demographics
NPI:1336976810
Name:RR ACOSTA LLC
Entity type:Organization
Organization Name:RR ACOSTA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEDA ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-665-6567
Mailing Address - Street 1:10500 SW 108TH AVE APT B207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8603
Mailing Address - Country:US
Mailing Address - Phone:786-307-9365
Mailing Address - Fax:
Practice Address - Street 1:9350 SW 72ND ST STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3245
Practice Address - Country:US
Practice Address - Phone:786-665-6567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty