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General NPI Number Information
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NPI Number | 1366205775
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Entity Type | Individual
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Provider Name | RONALD DON COSTA
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Gender | Male
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Dates
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Enumeration Date | 01/31/2024
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 6655 W SAHARA AVE STE 113-114
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City | LAS VEGAS
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State | NV
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Zip | 89146-0842
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Country | US
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Telephone | 615-713-7465
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Fax |
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Provider Business Mailing Address
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Address Line | 192 MACOBY RUN ST
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City | LAS VEGAS
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State | NV
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Zip | 89148-2628
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Country | US
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Telephone | 615-713-7465
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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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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