Provider Demographics
NPI:1760774004
Name:KOSTOLIAS, ALESSANDRA FERREIRA (MD)
Entity Type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:FERREIRA
Last Name:KOSTOLIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 ALTON RD STE 940
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2890
Mailing Address - Country:US
Mailing Address - Phone:305-674-2655
Mailing Address - Fax:
Practice Address - Street 1:4302 ALTON RD STE 940
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33140-2890
Practice Address - Country:US
Practice Address - Phone:305-674-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA155500207V00000X
390200000X
FLME148513207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty