1760510143 NPI number — ISABEL COSTALES

Table of content: ISABEL COSTALES (NPI 1760510143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760510143 NPI number — ISABEL COSTALES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSTALES
Provider First Name:
ISABEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760510143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 CAMPUS DR
Provider Second Line Business Mailing Address:
ANNEX
Provider Business Mailing Address City Name:
HANFORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93230-4375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-582-3211
Provider Business Mailing Address Fax Number:
559-582-8388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 CAMPUS DR
Provider Second Line Business Practice Location Address:
ANNEX
Provider Business Practice Location Address City Name:
HANFORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93230-4375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-582-3211
Provider Business Practice Location Address Fax Number:
559-582-8388
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  3405 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3405 . This is a "NURSE PRACTITIONER LICENS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 276256 . This is a "RN LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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