Individual
LARISSA GOUVEA JOSE FELICIO DA COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
167 ASHLEY AVE, CHARLESTON, SC 29425-8905
(843) 792-2020
Mailing address
167 ASHLEY AVE, CHARLESTON, SC 29425-8905
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MMD90902AL
SC
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
MMD90902AL
SC
207WX0120X
Cornea and External Diseases Specialist Physician
MMD90902AL
SC
Other
Enumeration date
09/19/2023
Last updated
08/05/2024
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