Provider Demographics
NPI:1386026243
Name:COSTOPOULOS, YAZMIN
Entity Type:Individual
Prefix:
First Name:YAZMIN
Middle Name:
Last Name:COSTOPOULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S 1ST ST
Mailing Address - Street 2:APT. 1024
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6387
Mailing Address - Country:US
Mailing Address - Phone:512-825-6815
Mailing Address - Fax:
Practice Address - Street 1:3200 S 1ST ST
Practice Address - Street 2:APT. 1024
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6387
Practice Address - Country:US
Practice Address - Phone:512-825-6815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula