Basic Information
Provider Information
NPI: 1902351083
EntityType: 2
ReplacementNPI:  
OrganizationName: RAFAEL DIAZ ACOSTA, MD PA
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6140 SW 70TH ST
Address2: 2ND FLOOR
City: SOUTH MIAMI
State: FL
PostalCode: 331433419
CountryCode: US
TelephoneNumber: 3052847577
FaxNumber: 3052847706
Practice Location
Address1: 6140 SW 70TH ST
Address2: 2ND FLOOR
City: SOUTH MIAMI
State: FL
PostalCode: 331433419
CountryCode: US
TelephoneNumber: 3052847577
FaxNumber: 3052847706
Other Information
ProviderEnumerationDate: 08/18/2016
LastUpdateDate: 08/18/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DIAZ ACOSTA
AuthorizedOfficialFirstName: RAFAEL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: MD/OWNER
AuthorizedOfficialTelephone: 8326066735
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XME129046FLY193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 

No ID Information.


Home