MEDICARE: GABRIEL A COSTA MD PA

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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1669729927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GABRIEL A COSTA MD PA

Provider Business Mailing Address
First Line	:	3181 CORAL WAY
Second Line	:	SUITE 301
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3216
Country	:	US
Telephone Number	:	305-444-4546
Fax Number	:

Provider Business Practice Location Address
First Line	:	3181 CORAL WAY
Second Line	:	SUITE 301
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3216
Country	:	US
Telephone Number	:	305-444-4546
Fax Number	:

Authorized Official
Title or Position	:	BILLING AGENT
Name	:	JUAN J LOPEZ
Credential	:
Telephone Number	:	305-251-3991

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	09/25/2012

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