Provider Demographics
NPI:1043748072
Name:COSTELOE, ANNA (DO)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:COSTELOE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANYA
Other - Middle Name:
Other - Last Name:COSTELOE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3770 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1706
Mailing Address - Country:US
Mailing Address - Phone:720-434-1662
Mailing Address - Fax:
Practice Address - Street 1:2400 CLAY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1809
Practice Address - Country:US
Practice Address - Phone:415-567-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-04
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A19296207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program