Provider Demographics
NPI:1487767604
Name:CONSTANTINO, LOIDA (MD)
Entity type:Individual
Prefix:DR
First Name:LOIDA
Middle Name:
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1777 BELLFLOWER BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815
Mailing Address - Country:US
Mailing Address - Phone:562-961-8820
Mailing Address - Fax:562-961-8828
Practice Address - Street 1:1777 BELLFLOWER BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815
Practice Address - Country:US
Practice Address - Phone:562-961-8820
Practice Address - Fax:562-961-8828
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A398400OtherBLUE SHIELD
CA00A398400Medicaid
CAF52348Medicare UPIN
CAWA39840MMedicare ID - Type Unspecified