Individual
DR. JESSE LEE COSTALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3009 W MCRAE WAY, PHOENIX, AZ 85027-4915
(602) 353-2340
Mailing address
3009 W MCRAE WAY, PHOENIX, AZ 85027-4915
(909) 772-2963
(094) 067-0959
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
58656
AZ
Other
Enumeration date
03/28/2011
Last updated
05/24/2024
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