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General NPI Number Information
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NPI Number | 1194271718
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Entity Type | Individual
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Provider Name | CINDY COSTA LMP
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Gender | Female
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 38579 SE RIVER STREET SUITE 13
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City | SNOQUALMIE
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State | WA
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Zip | 98065
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Country | US
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Telephone | 425-208-5048
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2355
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City | NORTH BEND
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State | WA
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Zip | 98045-2355
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Country | US
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Telephone | 425-894-1015
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 00005988
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License Number State | WA
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