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Organization
COSTA CLINIC PLLC
Active
Organization
COSTA CLINIC PLLC
Active
Other names
Scottsdale Premier Care
Organization subpart
No
Provider details
NPI number
Authorized official
PRIYANKA COSTA HENNIS MD (MEDICAL DIRECTOR)
(312) 625-0574
Entity
Organization
Contact information
Practice address
3811 E BELL RD STE 106, PHOENIX, AZ 85032-2158
(602) 443-1085
(602) 443-1086
Mailing address
1628 E SOUTHERN AVE STE 9803, TEMPE, AZ 85282-5782
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/29/2023
Last updated
12/14/2023
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