Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 3058 | OR |
NPI | 1114382694 |
---|---|
Provider Name | Dr. Miranda J Costa |
First Address | Portland, OR 97206-1215 |
Second Address | Portland, OR 97206-1215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2015 |
Last Update Date | 28/12/2015 |