Individual
DR. MARK COSTOPOULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
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
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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