Provider Demographics
NPI:1194844027
Name:COSTA, MIGDALIA MEJIA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:MIGDALIA
Middle Name:MEJIA
Last Name:COSTA
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D STREET #B23 EXT. ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-383-6686
Mailing Address - Fax:
Practice Address - Street 1:SERGIO CUEVAS BUSTAMANTE STREET
Practice Address - Street 2:# 555 DOMENECH CORNER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-758-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical