Provider Demographics
NPI:1780858431
Name:COSTA, VANESSA I
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:COSTA
Suffix:I
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 1:12813 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4118
Mailing Address - Country:US
Mailing Address - Phone:562-693-0400
Mailing Address - Fax:562-693-0422
Practice Address - Street 1:12813 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4118
Practice Address - Country:US
Practice Address - Phone:562-693-0400
Practice Address - Fax:562-693-0422
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02870709Medicare PIN