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General NPI Number Information
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NPI Number | 1588680995
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Entity Type | Individual
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Provider Name | CYNTHIA J.E. COSTA D.C.
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Gender | Female
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 330 PARK AVE SUITE 3
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2352
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Country | US
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Telephone | 949-497-2553
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Fax | 949-497-5273
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Provider Business Mailing Address
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Address Line | 330 PARK AVE SUITE 3
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2352
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Country | US
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Telephone | 949-497-2553
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Fax | 949-497-5273
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC29364
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License Number State | CA
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