MEDICARE: MS. SHERINE BERNADETTE COSTA MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	42625	CA

General Provider Information

NPI Number	:	1851486245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERINE BERNADETTE COSTA MFT

Provider Business Mailing Address
First Line	:	5301 BRANSFORD DR.
Second Line	:
City	:	LA PALMA
State	:	CA
Zip	:	90623
Country	:	US
Telephone Number	:	714-872-0691
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 S GRAND AVE STE B
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-4434
Country	:	US
Telephone Number	:	714-567-7681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	02/26/2026

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