Provider Demographics
NPI:1952592487
Name:CONSTANTINO, REBECCA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5748
Mailing Address - Country:US
Mailing Address - Phone:361-573-9181
Mailing Address - Fax:361-572-5126
Practice Address - Street 1:2701 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5748
Practice Address - Country:US
Practice Address - Phone:361-573-9181
Practice Address - Fax:361-572-5126
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05051363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198870103Medicaid
TX198870104Medicaid
TX198870102Medicaid
TXTXB132110Medicare PIN
TX198870104Medicaid
TXTXB132111Medicare PIN