Provider Demographics
NPI:1912942749
Name:LAMPROPOULOS, CONSTANTINA (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANTINA
Middle Name:
Last Name:LAMPROPOULOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8599 HAVEN AVE.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RANCHO CUCAMONGO
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4849
Mailing Address - Country:US
Mailing Address - Phone:909-620-8180
Mailing Address - Fax:909-919-7288
Practice Address - Street 1:1902 ROYALTY DR
Practice Address - Street 2:SUITE 220
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3030
Practice Address - Country:US
Practice Address - Phone:909-620-8180
Practice Address - Fax:909-469-6741
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG684432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE64327Medicare UPIN
CA00G684430Medicare ID - Type Unspecified