Individual
MARC O COSTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2728 OAKHURST DR, OAKDALE, CA 95361-9233
(209) 840-3456
Mailing address
2728 OAKHURST DR, OAKDALE, CA 95361-9233
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/12/2019
Last updated
09/12/2019
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