Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 15465 | CA |
NPI | 1083937965 |
---|---|
Provider Name | Pamela Costa |
First Address | Los Angeles, CA 90027 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2010 |
Last Update Date | 08/03/2010 |