Provider Demographics
NPI:1740403872
Name:COSTA, HILDEGARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:HILDEGARDO
Middle Name:
Last Name:COSTA
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 1:1200 E RIDGE RD
Mailing Address - Street 2:STE #12
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1527
Mailing Address - Country:US
Mailing Address - Phone:956-631-5333
Mailing Address - Fax:956-631-5803
Practice Address - Street 1:1200 E RIDGE RD
Practice Address - Street 2:STE #12
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1527
Practice Address - Country:US
Practice Address - Phone:956-631-5333
Practice Address - Fax:956-631-5803
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3199208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics