Provider Demographics
NPI:1285256081
Name:COSTA, ALOIZIO VERONICO
Entity type:Individual
Prefix:
First Name:ALOIZIO
Middle Name:VERONICO
Last Name:COSTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 MARK TWAIN DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8358
Mailing Address - Country:US
Mailing Address - Phone:415-724-7861
Mailing Address - Fax:925-481-2943
Practice Address - Street 1:1435 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2847
Practice Address - Country:US
Practice Address - Phone:415-724-7861
Practice Address - Fax:925-481-2943
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB9768225172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver