Provider Demographics
NPI:1235919903
Name:COSTA, WILLIAM NUNES (LSA, SA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:NUNES
Last Name:COSTA
Suffix:
Gender:M
Credentials:LSA, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 HILLSIDE LAKE TER APT 605
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5242
Mailing Address - Country:US
Mailing Address - Phone:443-910-0033
Mailing Address - Fax:
Practice Address - Street 1:903 HILLSIDE LAKE TER APT 605
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5242
Practice Address - Country:US
Practice Address - Phone:443-910-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSA2000032246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant