Provider Demographics
NPI:1790145084
Name:HOLT, ANOUCHKA COSTE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANOUCHKA
Middle Name:COSTE
Last Name:HOLT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANOUCHKA
Other - Middle Name:HELENE
Other - Last Name:COSTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 CLINT MOORE RD STE 210
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-5716
Practice Address - Country:US
Practice Address - Phone:561-488-1801
Practice Address - Fax:561-451-1480
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A19562208600000X
NY296231208600000X
FLOS20225208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery