Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | T1020 | TX |
NPI | 1003292525 |
---|---|
Provider Name | Vaneska Bottino Da Costa |
First Address | El Paso, TX 79905-1613 |
Second Address | El Paso, TX 79905-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2015 |
Last Update Date | 02/07/2021 |