Individual
MR. ROBERT O. COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
19 CAMINO LINDA, TIJERAS, NM 87059-8041
(505) 417-6182
Mailing address
19 CAMINO LINDA, TIJERAS, NM 87059-8041
(505) 417-6182
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
5365
NM
Other
Enumeration date
07/09/2007
Last updated
11/13/2019
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