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General NPI Number Information
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NPI Number | 1114382694
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Entity Type | Individual
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Provider Name | MIRANDA J COSTA ND
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Gender | Female
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 07/20/2025
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Provider Practice Location Address
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Address Line | 1215 NE 7TH ST STE D
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City | GRANTS PASS
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State | OR
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Zip | 97526-1450
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Country | US
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Telephone | 541-778-4130
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Fax | 541-325-4089
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Provider Business Mailing Address
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Address Line | 1215 NE 7TH ST STE D
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City | GRANTS PASS
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State | OR
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Zip | 97526-1450
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Country | US
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Telephone | 541-655-3870
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Fax | 541-325-4089
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 3058
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License Number State | OR
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