Provider Demographics
NPI:1427428671
Name:AUGUSTO DA COSTA, LEILA ELVIRA
Entity type:Individual
Prefix:
First Name:LEILA ELVIRA
Middle Name:
Last Name:AUGUSTO DA COSTA
Suffix:
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 1:11818 MOORPARK ST UNIT E
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2161
Mailing Address - Country:US
Mailing Address - Phone:818-738-9920
Mailing Address - Fax:
Practice Address - Street 1:11818 MOORPARK ST UNIT E
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2161
Practice Address - Country:US
Practice Address - Phone:818-738-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89111106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist