Provider Demographics
NPI:1689793085
Name:COSTAS, PATRICIA
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:COSTAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANSION DEL SUR 21 CEIBA ST.
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:851 CALLE CAMPECHE
Practice Address - Street 2:SUITE 2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1670
Practice Address - Country:US
Practice Address - Phone:787-487-0105
Practice Address - Fax:787-841-5078
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4722183500000X, 1835G0303X, 1835N1003X, 1835P1200X, 1835P1300X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
Not Answered1835X0200XPharmacy Service ProvidersPharmacistOncology