Organization
MARK COSTOPOULOS DPM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK COSTOPOULOS DPM (OWNER/PODIATRIST)
(310) 376-3668
Entity
Organization
Contact information
Practice address
6333 WILSHIRE BLVD, SUITE 304, LOS ANGELES, CA 90048-5702
(310) 376-3668
(310) 376-8777
Mailing address
6333 WILSHIRE BLVD, SUITE 304, LOS ANGELES, CA 90048-5702
(310) 376-3668
(310) 376-8777
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E2607
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E26071
—
CA
01
—
4800033100
RAILROAD MEDICARE
CA
01
—
E2607B
MEDICARE LICENSE
CA
Enumeration date
01/16/2008
Last updated
02/26/2008
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