Provider Demographics
NPI:1093201923
Name:DA COSTA, CHRISTINA MARTINEZ
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARTINEZ
Last Name:DA COSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 E 700 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-3812
Mailing Address - Country:US
Mailing Address - Phone:801-244-7397
Mailing Address - Fax:
Practice Address - Street 1:7625 S 3200 W STE 2
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-2887
Practice Address - Country:US
Practice Address - Phone:801-915-0359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical