Healthcare Provider Details

I. General information

NPI: 1689793085
Provider Name (Legal Business Name): DR. PATRICIA COSTAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 CALLE CAMPECHE SUITE 2
PONCE PR
00717-1670
US

IV. Provider business mailing address

MANSION DEL SUR 21 CEIBA ST.
COTO LAUREL PR
00780-2076
US

V. Phone/Fax

Practice location:
  • Phone: 787-487-0105
  • Fax: 787-841-5078
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4722
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number4722
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number4722
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number4722
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number4722
License Number StatePR
# 6
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number4722
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: