Provider Demographics
NPI:1821583006
Name:RODRIGUES COSTA, LETICIA (PSYD)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:RODRIGUES COSTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:LETICIA
Other - Middle Name:
Other - Last Name:RODRIGUES COSTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1120 W LA VETA AVE STE 470
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4233
Mailing Address - Country:US
Mailing Address - Phone:714-509-0481
Mailing Address - Fax:
Practice Address - Street 1:1120 W LA VETA AVE STE 470
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4233
Practice Address - Country:US
Practice Address - Phone:347-255-6489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94026834103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist