Provider Demographics
NPI:1659607554
Name:CALLA DE COSTE, ANA MARIA (DA)
Entity Type:Individual
Prefix:MS
First Name:ANA
Middle Name:MARIA
Last Name:CALLA DE COSTE
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WINSLOW ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1726
Mailing Address - Country:US
Mailing Address - Phone:401-330-7006
Mailing Address - Fax:401-433-0420
Practice Address - Street 1:28 WINSLOW ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1726
Practice Address - Country:US
Practice Address - Phone:401-330-7006
Practice Address - Fax:401-433-0420
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00339171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist