Basic Information
| Provider Information | |||||||||
| NPI: | 1275624512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DACOSTA-IYER | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 EMERALD | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492621148 | ||||||||
| FaxNumber: | 9496458856 | ||||||||
| Practice Location | |||||||||
| Address1: | 5901 E 7TH ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628265513 | ||||||||
| FaxNumber: | 5628265623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | A43948 | CA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.