Provider Demographics
NPI:1669729927
Name:GABRIEL A COSTA MD PA
Entity type:Organization
Organization Name:GABRIEL A COSTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-251-3991
Mailing Address - Street 1:3181 CORAL WAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3216
Mailing Address - Country:US
Mailing Address - Phone:305-444-4546
Mailing Address - Fax:
Practice Address - Street 1:3181 CORAL WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3216
Practice Address - Country:US
Practice Address - Phone:305-444-4546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty