Provider Demographics
NPI:1710355789
Name:RAMOS-COSTA, LOURDES
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:RAMOS-COSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LOURDES
Other - Middle Name:R
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:50 N BROADWAY
Mailing Address - Street 2:APT. 5J
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3737
Mailing Address - Country:US
Mailing Address - Phone:917-504-5905
Mailing Address - Fax:
Practice Address - Street 1:50 N BROADWAY
Practice Address - Street 2:APT. 5J
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3737
Practice Address - Country:US
Practice Address - Phone:917-504-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program