Healthcare Provider Details

I. General information

NPI: 1447189790
Provider Name (Legal Business Name): JOANNA COSTA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 S 10TH ST
GROVER BEACH CA
93433-2418
US

IV. Provider business mailing address

1430 RAILROAD ST APT 6
OCEANO CA
93445-9645
US

V. Phone/Fax

Practice location:
  • Phone: 805-474-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number27612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: