Basic Information
Provider Information
NPI: 1124414180
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MONTEIRO
FirstName: ANA CAROLINA COSTA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D./PHD
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
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Mailing Information
Address1: 5767 W CENTURY BLVD STE 400
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900455631
CountryCode: US
TelephoneNumber: 3103018771
FaxNumber:  
Practice Location
Address1: 200 UCLA MEDICAL PLZ STE 365B
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900958358
CountryCode: US
TelephoneNumber: 3108252448
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/07/2015
LastUpdateDate: 07/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X CAN Student, Health CareStudent in an Organized Health Care Education/Training Program 
207RP1001XA149651CAY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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