Costopoulos, Mark

Costopoulos, Mark is an sole proprietor health care provider with primary practice located at 608 N Sepulveda Blvd , Manhattan Beach CA 90266-5921. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Costopoulos, Mark can be contacted via phone (310) 376-3668.

Contact Information

Primary practice address
608 N Sepulveda Blvd Manhattan Beach CA 90266-5921
Phone: (310) 376-3668
Fax: (310) 376-8777
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X E2607 California

Profile Details

NPI number 1669477717
LBN Legal business name Costopoulos, Mark
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 16th, 2005
Last updated Oct 27th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669477717 NPPES
California MEDICAID 000E26070
California Other E2607A

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