| Doctor Name: | CHARLENE EDMEE DACOSTA |
| NPI Number: | 1306802905 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | ACN813 |
| Business Practice Address: | 790 Buenaventura Blvd Kissimmee, FL - 347438128 |
| Business Phone Number: | 4073449959 |
| Business Fax Number: | 4073449971 |
| Mailing Address: | 121 S Orange Ave Ste 940, ORLANDO |
| State: | FL |
| Postal Code: | 328013234 |
| Phone Number: | 3213326947 |
| Fax Number: | 4076589688 |
| NPI Enumeration Date: | 04/22/2006 |
| NPI Last Update Date: | 06/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ACN813 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |