Provider Demographics
NPI:1669586293
Name:CONSTANTINE, CARL A (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:CONSTANTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660640
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-0640
Mailing Address - Country:US
Mailing Address - Phone:626-447-0297
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:825 N 10TH ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-1309
Practice Address - Country:US
Practice Address - Phone:805-647-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG68370OtherMEDICAL LICENSE
CAWG68370KMedicare PIN
CAE82271Medicare UPIN