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General NPI Number Information
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NPI Number | 1235300310
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Entity Type | Organization
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Legal Business Name | MARK COSTOPOULOS DPM
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 608 N SEPULVEDA BLVD
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5921
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Country | US
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Telephone | 310-376-3668
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Fax | 310-376-8777
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Provider Business Mailing Address
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Address Line | 608 N SEPULVEDA BLVD
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5921
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Country | US
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Telephone | 310-376-3668
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Fax | 310-376-8777
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK COSTOPOULOS
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Credential | D.P.M.
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Telephone | 310-376-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | E2607
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License Number State | CA
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