Provider Demographics
NPI:1366852782
Name:GRILLO-ACOSTA MD PA
Entity type:Organization
Organization Name:GRILLO-ACOSTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:SANTIAGO
Authorized Official - Last Name:GRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-222-5005
Mailing Address - Street 1:8420 WEST FLAGLER ST SUITE 218
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144
Mailing Address - Country:US
Mailing Address - Phone:305-222-5005
Mailing Address - Fax:
Practice Address - Street 1:8420 WEST FLAGLER ST SUITE 218
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:305-222-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty