Healthcare Provider Details

I. General information

NPI: 1134242605
Provider Name (Legal Business Name): RITA ROTH COSTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6369 E TANQUE VERDE RD STE 220
TUCSON AZ
85715-3834
US

IV. Provider business mailing address

4341 E PRESIDIO PL
TUCSON AZ
85712-1120
US

V. Phone/Fax

Practice location:
  • Phone: 520-298-8388
  • Fax:
Mailing address:
  • Phone: 520-881-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN031988
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: