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:
Health care specialties
Specialty | Code | License # | 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 16 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1669477717 | NPPES |
California | MEDICAID | 000E26070 | |
California | Other | E2607A |
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