Provider Demographics
NPI:1427463504
Name:NOSTRUM MEDICAL CENTER NW LLC
Entity type:Organization
Organization Name:NOSTRUM MEDICAL CENTER NW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NILDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-642-2345
Mailing Address - Street 1:2141 NW 7TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3483
Mailing Address - Country:US
Mailing Address - Phone:305-642-2345
Mailing Address - Fax:305-642-2615
Practice Address - Street 1:2141 NW 7TH ST
Practice Address - Street 2:STE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3483
Practice Address - Country:US
Practice Address - Phone:305-642-2345
Practice Address - Fax:305-642-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061179208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty