Individual
DR. THERESA L. COSTALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1201 S 7TH AVE STE 150, PHOENIX, AZ 85007-4075
(716) 628-6338
Mailing address
2390 E CAMELBACK RD STE 400, PHOENIX, AZ 85016-3479
(716) 628-6338
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
280190-1
NY
2084P0800X
Psychiatry Physician
Primary
57600
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2013
Last updated
02/16/2022
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