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General NPI Number Information
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NPI Number | 1780043679
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Entity Type | Organization
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Legal Business Name | FERNANDO COSTAS
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Dates
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Enumeration Date | 02/19/2016
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Last Update Date | 02/19/2016
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Provider Practice Location Address
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Address Line | 7 CARR 877 # KM MARGINAL TRUJILLO ALTO
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City | SAN JUAN
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State | PR
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Zip | 00926-8212
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Country | US
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Telephone | 939-204-8074
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 43002 SUITE 515
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City | RIO GRANDE
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State | PR
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Zip | 00745-6601
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Country | US
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Telephone | 787-221-3421
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Fax |
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Authorized Official
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Title or Position | SPEECH AND LANGUAGE PATHOLOGIST
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Name | MR. FERNANDO COSTAS
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Credential | M
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Telephone | 787-508-6919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1086
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License Number State | PR
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