Individual
GENEVIEVE COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
4306 ALTON RD FL 2D, MIAMI BEACH, FL 33140-2840
(305) 674-2397
(305) 674-2863
Mailing address
4306 ALTON RD FL 2D, MIAMI BEACH, FL 33140-2840
(305) 674-2397
(305) 674-2863
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9104431
FL
Other
Enumeration date
07/21/2005
Last updated
02/24/2010
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