Healthcare Provider Details

I. General information

NPI: 1609335280
Provider Name (Legal Business Name): ADRIANA COSTA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42301 10TH ST W
LANCASTER CA
93534-7000
US

IV. Provider business mailing address

42301 10TH ST W
LANCASTER CA
93534-7000
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-2202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: