Provider Demographics
NPI:1447687504
Name:LOPEZACOSTA, ALBERTO (AP)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:LOPEZACOSTA
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 SW 28TH LN
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3135
Mailing Address - Country:US
Mailing Address - Phone:305-608-4922
Mailing Address - Fax:
Practice Address - Street 1:2640 SW 28TH LN
Practice Address - Street 2:
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-3135
Practice Address - Country:US
Practice Address - Phone:305-608-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA54547225700000X
FLAP3432171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist