Healthcare Provider Details

I. General information

NPI: 1194972166
Provider Name (Legal Business Name): NIRALLI D'COSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 LINCOLN AVE.
OAKLAND CA
94602-2529
US

IV. Provider business mailing address

4368 LINCOLN AVE
OAKLAND CA
94602-2529
US

V. Phone/Fax

Practice location:
  • Phone: 510-531-3111
  • Fax: 510-530-8083
Mailing address:
  • Phone: 310-801-0845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: