Provider Demographics
NPI:1013996305
Name:CONSTANCE C CORSINO MD INC
Entity Type:Organization
Organization Name:CONSTANCE C CORSINO MD INC
Other - Org Name:CHILDRENS MEDICAL GROUP OF CHINO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:CHAPPELL
Authorized Official - Last Name:CORSINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-627-7433
Mailing Address - Street 1:12574 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710
Mailing Address - Country:US
Mailing Address - Phone:909-627-7433
Mailing Address - Fax:909-627-8573
Practice Address - Street 1:12574 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-627-7433
Practice Address - Fax:909-627-8573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25276208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E99018Medicare UPIN
CA00G252760Medicare ID - Type Unspecified