Provider Demographics
NPI:1326753930
Name:COSTA, ALAN ANTOINE
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:ANTOINE
Last Name:COSTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2236
Mailing Address - Country:US
Mailing Address - Phone:781-807-1069
Mailing Address - Fax:
Practice Address - Street 1:176 WEST ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2236
Practice Address - Country:US
Practice Address - Phone:781-807-1069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach