# COSTA ESTE MEDICAL SERVICES LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** COSTA ESTE MEDICAL SERVICES LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174007470
- **Authorized official:** MRS. ISMARY M GONZALEZ DO (PRESIDENT)
- **Authorized official phone:** (787) 646-7769

## Contact information

- **Practice address:** AVE PRINCIPAL F4, URB BARALT, FAJARDO, PR 00738
- **Practice address phone:** (787) 860-3700
- **Practice address fax:** (787) 860-3800
- **Mailing address:** PO BOX 1001, LUQUILLO, PR 00773-1001
- **Mailing address phone:** (787) 860-3700
- **Mailing address fax:** (787) 860-3800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 09/21/2018
- **Last updated:** 09/21/2018