Individual
BRANDON OMAR COSTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2251 W LINGLEVILLE RD APT 24B, STEPHENVILLE, TX 76401-6008
(325) 330-2294
Mailing address
2251 W LINGLEVILLE RD APT 24B, STEPHENVILLE, TX 76401-6008
(325) 330-2294
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
337342
TX
Other
Enumeration date
03/29/2019
Last updated
03/29/2019
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