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
—
—
Other
Enumeration date
11/29/2023
Last updated
12/14/2023
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