Provider Demographics
NPI:1740978030
Name:KASEBWA, JANE COSTA
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:COSTA
Last Name:KASEBWA
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 1:700 S MANHATTAN PL APT 425
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-4134
Mailing Address - Country:US
Mailing Address - Phone:949-501-6923
Mailing Address - Fax:
Practice Address - Street 1:700 S MANHATTAN PL APT 425
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-4134
Practice Address - Country:US
Practice Address - Phone:949-501-6923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95245278163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical