Individual
MR. COSTA VIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4580 W 173RD ST APT 115, LAWNDALE, CA 90260-3440
(310) 421-4233
Mailing address
4580 W 173RD ST APT 115, LAWNDALE, CA 90260-3440
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-HNGJYI
CA
Other
Enumeration date
12/18/2023
Last updated
12/18/2023
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