Provider Demographics
NPI:1962620419
Name:COSTA, VICTOR JOSEPH (CPED)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:JOSEPH
Last Name:COSTA
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 30TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1103
Mailing Address - Country:US
Mailing Address - Phone:205-354-3634
Mailing Address - Fax:
Practice Address - Street 1:2856 18TH ST S
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2510
Practice Address - Country:US
Practice Address - Phone:205-879-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALCPED24481744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management