Provider Demographics
NPI:1558338616
Name:COSTAS, PABLO J (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:J
Last Name:COSTAS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:139 CALLE MIMOSA
Mailing Address - Street 2:SANTA MARIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6215
Mailing Address - Country:US
Mailing Address - Phone:787-765-1630
Mailing Address - Fax:787-756-6957
Practice Address - Street 1:1056 AVE MUNOZ RIVERA
Practice Address - Street 2:FIRST FEDERAL BLDG SUITE 405
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5015
Practice Address - Country:US
Practice Address - Phone:787-765-1630
Practice Address - Fax:787-756-6957
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PR11925207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70244Medicare UPIN
PR0089586Medicare ID - Type Unspecified