Provider Demographics
NPI:1780043679
Name:FERNANDO COSTAS
Entity Type:Organization
Organization Name:FERNANDO COSTAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTAS
Authorized Official - Suffix:
Authorized Official - Credentials:M
Authorized Official - Phone:787-508-6919
Mailing Address - Street 1:PO BOX 43002
Mailing Address - Street 2:SUITE 515
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-6601
Mailing Address - Country:US
Mailing Address - Phone:787-221-3421
Mailing Address - Fax:
Practice Address - Street 1:7 CARR 877 # KM
Practice Address - Street 2:MARGINAL TRUJILLO ALTO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-8212
Practice Address - Country:US
Practice Address - Phone:939-204-8074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty