Provider Demographics
NPI:1366205775
Name:COSTA, RONALD DON
Entity type:Individual
Prefix:
First Name:RONALD DON
Middle Name:
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 1:192 MACOBY RUN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2628
Mailing Address - Country:US
Mailing Address - Phone:615-713-7465
Mailing Address - Fax:
Practice Address - Street 1:6655 W SAHARA AVE STE 113-114
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0842
Practice Address - Country:US
Practice Address - Phone:615-713-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based