MEDICARE: MR. RAYMOND COSTELLO PPSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor		CA

General Provider Information

NPI Number	:	1669356804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND COSTELLO PPSC

Provider Business Mailing Address
First Line	:	1698 SEVILLE ST
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93906-2329
Country	:	US
Telephone Number	:	541-301-2129
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 S MAIN ST
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93901-2403
Country	:	US
Telephone Number	:	831-753-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/01/2025

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