Individual
HEATHER COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPSS
Contact information
Practice address
5485 PIRE AVE, SAN DIEGO, CA 92122-4125
(858) 220-3231
Mailing address
5485 PIRE AVE, SAN DIEGO, CA 92122-4125
(858) 220-3231
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-KEFXHO
CA
Other
Enumeration date
10/31/2024
Last updated
10/31/2024
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