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Individual
DR. MARK COSTOPOULOS
Active
Individual
DR. MARK COSTOPOULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E2607
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E26070
—
CA
01
—
E2607A
MEDICARE LICENSE
CA
Enumeration date
06/16/2005
Last updated
10/27/2008
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