Provider Demographics
NPI:1215197231
Name:CAROL DA COSTA MD
Entity Type:Organization
Organization Name:CAROL DA COSTA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANA
Authorized Official - Last Name:DA COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-752-6465
Mailing Address - Street 1:15671 SW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1103
Mailing Address - Country:US
Mailing Address - Phone:305-752-6465
Mailing Address - Fax:305-752-6467
Practice Address - Street 1:15671 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1103
Practice Address - Country:US
Practice Address - Phone:305-752-6465
Practice Address - Fax:305-752-6467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269721100Medicaid