Organization
COSTON ENTERPRISES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DIANO R COSTON SR. (OWNER)
(813) 383-4674
Entity
Organization
Contact information
Practice address
1907 LANDSIDE DR, VALRICO, FL 33594-4421
(813) 383-4674
Mailing address
PO BOX 2232, VALRICO, FL 33595-2232
(813) 383-4674
(813) 383-4674
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
992277600
—
FL
Enumeration date
05/19/2008
Last updated
05/19/2008
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