Healthcare Provider Details

I. General information

NPI: 1629047543
Provider Name (Legal Business Name): ALICE COSTEN APN , DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23530 HAWTHORNE BLVD STE 290
TORRANCE CA
90505-4713
US

IV. Provider business mailing address

224 N FAIR OAKS AVE STE 300
PASADENA CA
91103-3618
US

V. Phone/Fax

Practice location:
  • Phone: 424-903-7007
  • Fax: 424-903-7009
Mailing address:
  • Phone: 626-696-1400
  • Fax: 626-696-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95028533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: