Provider Demographics
NPI:1225827736
Name:CONSTANTINO, ELEXUS MONIQUE (LVN)
Entity type:Individual
Prefix:MRS
First Name:ELEXUS
Middle Name:MONIQUE
Last Name:CONSTANTINO
Suffix:
Gender:
Credentials:LVN
Other - Prefix:MRS
Other - First Name:ELEXUS
Other - Middle Name:MONIQUE
Other - Last Name:BALLARD- RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8608 WEBER CT APT A
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-8668
Mailing Address - Country:US
Mailing Address - Phone:559-240-4196
Mailing Address - Fax:
Practice Address - Street 1:60805 TWENTYNINE PALMS HWY
Practice Address - Street 2:
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252
Practice Address - Country:US
Practice Address - Phone:760-974-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA733995164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty