Individual
KANOELANI COSTALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
425 S FRETZ AVE STE C, EDMOND, OK 73003-5568
(405) 757-7980
Mailing address
19501 N PENNSYLVANIA AVE, EDMOND, OK 73012-4802
(702) 448-0577
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
—
Other
Enumeration date
01/14/2025
Last updated
01/14/2025
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