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General NPI Number Information
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NPI Number | 1285256081
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Entity Type | Individual
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Provider Name | ALOIZIO VERONICO COSTA
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Gender | Male
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Dates
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Enumeration Date | 05/14/2020
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Last Update Date | 05/14/2020
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Provider Practice Location Address
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Address Line | 1435 4TH ST
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2847
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Country | US
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Telephone | 415-724-7861
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Fax | 925-481-2943
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Provider Business Mailing Address
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Address Line | 2412 MARK TWAIN DR
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City | ANTIOCH
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State | CA
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Zip | 94531-8358
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Country | US
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Telephone | 415-724-7861
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Fax | 925-481-2943
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | B9768225
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License Number State | CA
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