Individual
GINA COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
763 RIO RANCHO RD, POMONA, CA 91766-7015
(949) 338-6424
Mailing address
PO BOX 9083, ANAHEIM, CA 92812-7083
(949) 338-6424
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
44849
CA
Other
Enumeration date
05/15/2020
Last updated
05/15/2020
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