Organization
MARK COSTOPOULOS DPM
Active
Organization
MARK COSTOPOULOS DPM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK COSTOPOULOS D.P.M. (OWNER)
(310) 376-3668
Entity
Organization
Contact information
Practice address
608 N SEPULVEDA BLVD, MANHATTAN BEACH, CA 90266-5921
(310) 376-3668
(310) 376-8777
Mailing address
608 N SEPULVEDA BLVD, MANHATTAN BEACH, CA 90266-5921
(310) 376-3668
(310) 376-8777
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
E2607
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E26070
—
CA
01
—
E2607A
MEDICARE LICENSE #
CA
Enumeration date
03/18/2008
Last updated
03/18/2008
Update your record
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