Healthcare Provider Details

I. General information

NPI: 1215197231
Provider Name (Legal Business Name): CAROL DA COSTA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15671 SW 88TH ST
MIAMI FL
33196-1103
US

IV. Provider business mailing address

15671 SW 88TH ST
MIAMI FL
33196-1103
US

V. Phone/Fax

Practice location:
  • Phone: 305-752-6465
  • Fax: 305-752-6467
Mailing address:
  • Phone: 305-752-6465
  • Fax: 305-752-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL ANA DA COSTA
Title or Position: PRESIDENT
Credential: MD
Phone: 305-752-6465