Provider Demographics
NPI:1831708452
Name:CONSTANTINOU, EMMA BRAND (PA-C)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:BRAND
Last Name:CONSTANTINOU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:EMMA
Other - Middle Name:CAROLINE CARTER
Other - Last Name:BRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:763 S LOS ROBLES AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3740
Mailing Address - Country:US
Mailing Address - Phone:865-771-6931
Mailing Address - Fax:
Practice Address - Street 1:15107 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4597
Practice Address - Country:US
Practice Address - Phone:818-902-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical