Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 107229 | FL |
NPI | 1083861439 |
---|---|
Provider Name | Mayra Acosta |
First Address | Miami, FL 33133-4223 |
Second Address | Miami, FL 33133-4223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2008 |
Last Update Date | 02/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GF836Z | (02) |