Provider Demographics
NPI:1811759095
Name:GARCIA COSTAS, CRISTINA ISABEL
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ISABEL
Last Name:GARCIA COSTAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9931 W FLAGLER ST APT 514
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1866
Mailing Address - Country:US
Mailing Address - Phone:787-486-0033
Mailing Address - Fax:
Practice Address - Street 1:10000 SW 56TH ST STE 10
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7161
Practice Address - Country:US
Practice Address - Phone:786-638-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist