Mae Cecile Costello, L.AC.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC00936 Issued in OR

Practice address

2143 NE Broadway St Ste 107C
Portland, OR 97232-1512

Phone

(503) 309-3963

NPI assigned

Jun 13, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184828956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2143 NE BROADWAY ST STE 107C",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321512",
            "telephone_number": "503-309-3963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2143 NE BROADWAY ST STE 107C",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321512",
            "telephone_number": "503-309-3963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "MAE",
        "middle_name": "CECILE",
        "credential": "L.AC.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC00936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Elizabeth-O'Mara Costello, PA-C
• Chanda J Costello, DMD
• Desiree Porter Costello
• Elizabeth Natalia Costello, RN
• Jason Richard Costello, LAC
• Nicole Costello
• Stephanie Costello, MSW
• Tabitha Rochelle Costigan
• Mackenzie Elizabeth Coston, CGC
• Laurice Tabitha Cota, RDH

• Acupuncturist in Portland, OR
• Providers in Portland, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.