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General NPI Number Information
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NPI Number | 1407261522
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Entity Type | Individual
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Provider Name | ANNA-MARIA ALICIA DE COSTA MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 4200 BECKNER RD
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City | SANTA FE
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State | NM
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Zip | 87507-3774
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Country | US
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Telephone | 505-477-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 MINNEQUA AVE
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City | PUEBLO
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State | CO
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Zip | 81004-3733
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Country | US
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Telephone | 719-557-5460
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Fax | 719-557-4648
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | LL36893
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | DR.0061777
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD2024-0260
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 66208-20
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License Number State | WI
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