Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | RHC116746 | CA |
N | 213ER0200X | Radiology | RHC116746 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E2603 | CA |
NPI | 1548336605 |
---|---|
Provider Name | Walter Francis D'costa |
First Address | Santa Rosa, CA 95403-2905 |
Second Address | Santa Rosa, CA 95403-2905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 01/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E26030 | (05) | CA |
170924000 | US DEPARTMENT OF LABOR (01) | |
756480842 | RAILROAD MEDICARE (01) | |
T11397 | (02) |