Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME0056410 | FL |
NPI | 1013960772 |
---|---|
Provider Name | Dr. Jorge L Acosta |
First Address | Miami, FL 33144-0917 |
Second Address | Miami, FL 33144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E46018 | (02) |