MEDICARE: DR. MICHAEL COSTEINES PH.D.

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	103TC0700X	Clinical Psychologist	PSY26180	CA

General Provider Information

NPI Number	:	1851711741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL COSTEINES PH.D.

Provider Business Mailing Address
First Line	:	617 VETERANS BLVD
Second Line	:	SUITE 204
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1496
Country	:	US
Telephone Number	:	650-851-1952
Fax Number	:

Provider Business Practice Location Address
First Line	:	617 VETERANS BLVD
Second Line	:	SUITE 204
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1496
Country	:	US
Telephone Number	:	650-851-1952
Fax Number	:

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

Provider Enumeration Date	:	04/18/2014
Last Update Date	:	04/18/2014

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