Provider Demographics
NPI:1124463286
Name:CONSTANTINO, JACQUELINE SANTUILE (NP)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:SANTUILE
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:12898 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8546
Mailing Address - Country:US
Mailing Address - Phone:562-741-4420
Mailing Address - Fax:562-207-3714
Practice Address - Street 1:12898 TOWNE CENTER DR
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8546
Practice Address - Country:US
Practice Address - Phone:562-741-4420
Practice Address - Fax:562-207-3714
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA22937363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology