Provider Demographics
NPI:1790422376
Name:COSTA, BELINDA MARIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:MARIE
Last Name:COSTA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:BELINDA
Other - Middle Name:MARIE
Other - Last Name:ESPINOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:975 N D ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-4367
Mailing Address - Country:US
Mailing Address - Phone:209-993-4584
Mailing Address - Fax:
Practice Address - Street 1:975 N D ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-4367
Practice Address - Country:US
Practice Address - Phone:209-993-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532009163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator