Individual
KEVIN COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16528 E DESMET CT STE B3100, SPOKANE VALLEY, WA 99216-3522
(509) 944-9440
Mailing address
233 N HOUSTON RD STE 140E, WARNER ROBINS, GA 31093-3023
(478) 975-6880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP60948380
WA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/04/2016
Last updated
05/10/2021
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