Provider Demographics
NPI:1073054722
Name:COSTA, HELIO AZEVEDO (PHD)
Entity Type:Individual
Prefix:DR
First Name:HELIO
Middle Name:AZEVEDO
Last Name:COSTA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ARGUELLO ST APT 8
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1267
Mailing Address - Country:US
Mailing Address - Phone:209-581-1997
Mailing Address - Fax:
Practice Address - Street 1:3375 HILLVIEW AVE RM 2201
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1204
Practice Address - Country:US
Practice Address - Phone:209-581-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATRL01011727207SG0203X
CAMTP-02011990207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics