Provider Demographics
NPI:1306983960
Name:LOIDA P CONSTANTINO MD INC
Entity type:Organization
Organization Name:LOIDA P CONSTANTINO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOIDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CONSTANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-961-8820
Mailing Address - Street 1:1777 N BELLFLOWER BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4013
Mailing Address - Country:US
Mailing Address - Phone:562-961-8820
Mailing Address - Fax:562-961-8828
Practice Address - Street 1:1777 N BELLFLOWER BLVD
Practice Address - Street 2:STE 104
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4013
Practice Address - Country:US
Practice Address - Phone:562-961-8820
Practice Address - Fax:562-961-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A398400Medicaid
CA05D1028070OtherCLIA #
CA1487767604OtherNPI (TYPE-1)
CA05D1028070OtherCLIA #
CAW17864Medicare ID - Type UnspecifiedGROUP
CA00A398400Medicaid