MEDICARE: PABLO J COSTAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	11925	PR

General Provider Information

NPI Number	:	1558338616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PABLO J COSTAS M.D.

Provider Business Mailing Address
First Line	:	139 CALLE MIMOSA
Second Line	:	SANTA MARIA
City	:	SAN JUAN
State	:	PR
Zip	:	00927-6215
Country	:	US
Telephone Number	:	787-765-1630
Fax Number	:	787-756-6957

Provider Business Practice Location Address
First Line	:	1056 AVE MUNOZ RIVERA
Second Line	:	FIRST FEDERAL BLDG SUITE 405
City	:	SAN JUAN
State	:	PR
Zip	:	00927-5015
Country	:	US
Telephone Number	:	787-765-1630
Fax Number	:	787-756-6957

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	07/08/2007

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