# COSTA CLINIC PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Scottsdale Premier Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366218414
- **Authorized official:** PRIYANKA COSTA HENNIS MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (312) 625-0574

## Contact information

- **Practice address:** 3811 E BELL RD STE 106, PHOENIX, AZ 85032-2158
- **Practice address phone:** (602) 443-1085
- **Practice address fax:** (602) 443-1086
- **Mailing address:** 1628 E SOUTHERN AVE STE 9803, TEMPE, AZ 85282-5782

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/29/2023
- **Last updated:** 12/14/2023