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NPI Code Detail

MEDICARE: MRS. LETY ELIZABETH COSTA MD

MEDICARE: MRS. LETY ELIZABETH COSTA MD
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
1207Q00000XFamily Medicine PhysicianME158393FL
2363A00000XPhysician AssistantPA17517CA
3363A00000XPhysician Assistant680NE
4363LF0000XFamily Nurse Practitioner110879NE
5207R00000XInternal Medicine PhysicianA187054CA

General Provider Information

NPI Number : 1821188269
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LETY ELIZABETH COSTA MD
Provider Business Mailing Address
First Line : 749 EGGLESTON AVE
Second Line :
City : DOS PALOS
State : CA
Zip : 93620-9564
Country : US
Telephone Number : 208-282-0196
Fax Number : 855-202-9336
Provider Business Practice Location Address
First Line : 1405 CALIFORNIA AVE
Second Line :
City : DOS PALOS
State : CA
Zip : 93620-2300
Country : US
Telephone Number : 209-722-4842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2006
Last Update Date : 08/01/2025

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