Individual
MARILYN COSTACHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23542 STATE ROAD 54 STE 113, LUTZ, FL 33559-6753
(813) 214-6565
Mailing address
30841 KELMIN TER, WESLEY CHAPEL, FL 33543-6622
(305) 904-9291
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Enumeration date
05/31/2024
Last updated
05/31/2024
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