Individual
MR. BRIAN JOHN COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
2405 SHADELANDS DR STE 300, WALNUT CREEK, CA 94598-5906
(925) 939-8585
Mailing address
PO BOX 31396, WALNUT CREEK, CA 94598-8396
(925) 939-8585
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA15532
CA
Other
Enumeration date
10/10/2006
Last updated
01/23/2023
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