Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 44835 | TX |
NPI | 1023421617 |
---|---|
Provider Name | David Marin Costa |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2014 |
Last Update Date | 05/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
339090801 | (05) | TX |