=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811759095
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRISTINA ISABEL GARCIA COSTAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2024
-----------------------------------------------------
Last Update Date | 01/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10000 SW 56TH ST STE 10
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-7161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-638-2634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9931 W FLAGLER ST APT 514
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-1866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-486-0033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 11779
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------