Provider Demographics
NPI:1518038876
Name:COSTANZO, NATALIEANN (NP)
Entity Type:Individual
Prefix:
First Name:NATALIEANN
Middle Name:
Last Name:COSTANZO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 LOMITA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2076
Mailing Address - Country:US
Mailing Address - Phone:310-784-5800
Mailing Address - Fax:310-530-9811
Practice Address - Street 1:1403 LOMITA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2076
Practice Address - Country:US
Practice Address - Phone:310-784-5800
Practice Address - Fax:310-530-9811
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA606860163W00000X
CA2320364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist