Provider Demographics
NPI:1386601854
Name:ACOSTA, JOSE IGNACIO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:IGNACIO
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14255 SW 20TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7070
Mailing Address - Country:US
Mailing Address - Phone:305-551-5877
Mailing Address - Fax:
Practice Address - Street 1:4888 NW 183RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2900
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:305-688-7995
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME811172080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH70682Medicare UPIN