Provider Demographics
NPI:1669688164
Name:COSTELLO, JANAKI FOX
Entity Type:Individual
Prefix:MRS
First Name:JANAKI
Middle Name:FOX
Last Name:COSTELLO
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 1:710 HANCOCK WAY
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3005
Mailing Address - Country:US
Mailing Address - Phone:510-525-1155
Mailing Address - Fax:510-525-0955
Practice Address - Street 1:828 SAN PABLO AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1567
Practice Address - Country:US
Practice Address - Phone:510-525-1155
Practice Address - Fax:510-525-0955
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174400000XOther Service ProvidersSpecialist