Individual
DR. HENRY COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10555 VISTA DEL SOL DR, STE 120, EL PASO, TX 79925-7942
(915) 592-6868
(915) 592-6889
Mailing address
7812 GATEWAY BLVD E, SUITE 200, EL PASO, TX 79915-1803
(915) 592-6868
(915) 592-6889
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
K0009
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00W602
MEDICARE PROVIDER GROUP
—
05
—
116754606
—
TX
01
—
DF4091
RAILROAD MEDICARE
—
Enumeration date
06/21/2005
Last updated
09/03/2010
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