Individual
RICARDO COSTABELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4500 SPRING AVE, DALLAS, TX 75210-1350
(214) 865-3070
Mailing address
4500 SPRING AVE, DALLAS, TX 75210-1350
(214) 865-3070
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
10124
TX
Other
Enumeration date
12/08/2020
Last updated
12/08/2020
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