Provider Demographics
NPI:1437659257
Name:CONSTANTINO, ELVIRA BUCTON
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:BUCTON
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 FLAMINGO WAY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3314
Mailing Address - Country:US
Mailing Address - Phone:214-270-4150
Mailing Address - Fax:
Practice Address - Street 1:4020 FLAMINGO WAY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3314
Practice Address - Country:US
Practice Address - Phone:214-270-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227810164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse