NILDA ACOSTA MD PA
Suppliers at Krome Ave, Homestead, FL

License number
Florida ME61179
Category
Suppliers
Type
Non-Pharmacy Dispensing Site
Owner
Name: NILDA ACOSTA
Title: MANAGED CARE SPECIALIST
Phone: (800) 654-0889
Address
Address
1235 N Krome Ave, Homestead, FL 33030
National Provider ID: 1033223003
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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NILDA ACOSTA MD PA

1235 N Krome Ave, Homestead, FL 33030

Status:
Inactive
Industry:
Medical Doctor's Office
Doing business as:
Excellence Medical Center<br>Nilda Acosta MD
Inactive reason:
AMENDMENT AND NAME CHANGE
Registration:
Oct 16, 1995
Inactive since:
Feb 15, 2013
Phone:
(305) 242-5336 (Phone)
State ID:
P95000079929
Business type:
Florida Profit Corporation
President, Treasurer, Secretary, Director:
Nilda R Acosta (President, Treasurer, Secretary, Director), 22455 SW 182 Ave, Miami, FL 33170 (Physical)
Agent:
Nilda Acosta,1235 N Krome Ave, Homestead, FL 33030 (Physical)
EIN:
65-0619943

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