Provider Demographics
NPI:1447232152
Name:COSTAS, ANDRES F (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:F
Last Name:COSTAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 N TENAYA WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0456
Mailing Address - Country:US
Mailing Address - Phone:702-380-8111
Mailing Address - Fax:702-380-8028
Practice Address - Street 1:2931 N TENAYA WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0456
Practice Address - Country:US
Practice Address - Phone:702-380-8111
Practice Address - Fax:702-380-8028
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5728207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVD94346Medicare UPIN
NVVWQBGV18Medicare PIN
NVWQBGV18Medicare ID - Type Unspecified
NVWQBGV18Medicare PIN