Individual
TARLA GRACE VISPERAS COSTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
350 W THOMAS RD, PHOENIX, AZ 85013-4409
(203) 308-6701
Mailing address
9336 W COLTER ST, GLENDALE, AZ 85305-3364
(203) 308-6701
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
272933
AZ
Other
Enumeration date
04/26/2024
Last updated
04/26/2024
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