1699017459 NPI number — JAIME ACOSTA LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699017459 NPI number — JAIME ACOSTA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAIME ACOSTA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699017459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
253 NE 2ND ST APT 1704
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33132-2292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-525-7470
Provider Business Mailing Address Fax Number:
786-796-5253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
253 NE 2ND ST APT 1704
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33132-2292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-525-7470
Provider Business Practice Location Address Fax Number:
786-796-5253
Provider Enumeration Date:
03/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ACOSTA
Authorized Official First Name:
JAIME
Authorized Official Middle Name:
LEON
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
786-525-7470

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E1835B . This is a "MEDICARE PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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