Provider Information for 1063665529
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Dr. JENNIFER L. DE COSTA PhD, MFT, CSAC
Sex: Female
NPI: 1063665529
Last Updated: 2011-04-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1063665529 | ||||||||||||
| Enumeration Date | 2008-10-28 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 75-5751 KUAKINI HWY SUITE 105 KAILUA KONA, HI 96740-1752 United States Phone: 808-326-5629 | Fax:808-329-5057 | ||||||||||||
| Primary Practice Address | 75-5751 KUAKINI HWY SUITE 105 KAILUA KONA, HI 96740-1752 United States Phone: 808-326-5629 | Fax:808-329-5057 | ||||||||||||
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