Provider Demographics
NPI:1881031326
Name:KOSTURAKIS, RICARDO (M D)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:KOSTURAKIS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 N MESA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1118
Mailing Address - Country:US
Mailing Address - Phone:915-532-6767
Mailing Address - Fax:915-532-4023
Practice Address - Street 1:4301 N MESA ST STE 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1118
Practice Address - Country:US
Practice Address - Phone:915-532-6767
Practice Address - Fax:915-532-4023
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT0544207RC0000X, 207RI0011X
CAA133165207RG0300X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine