Individual
JONATHAN COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9415 FONTAINEBLEAU BLVD APT 106, MIAMI, FL 33172-5571
(786) 307-1151
Mailing address
9415 FONTAINEBLEAU BLVD APT 106, MIAMI, FL 33172-5571
(786) 307-1151
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
255-P.A.
PR
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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