Individual
BRANDON MICHAEL COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 532-6474
Mailing address
7493 HEINRICH RD, HAMBURG, NY 14075-6823
(716) 536-1534
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2012
Last updated
06/25/2019
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