1386814663 NPI number — MS. HELENA MIRIAM KOSTANTAS CNM

Table of content: MS. HELENA MIRIAM KOSTANTAS CNM (NPI 1386814663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386814663 NPI number — MS. HELENA MIRIAM KOSTANTAS CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOSTANTAS
Provider First Name:
HELENA
Provider Middle Name:
MIRIAM
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386814663
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14311 RAMORA BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALDWIN PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91706-0006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-338-0230
Provider Business Mailing Address Fax Number:
626-962-8854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14311 RAMONA BLVD
Provider Second Line Business Practice Location Address:
14311 RAMONA BLVD
Provider Business Practice Location Address City Name:
BALDWIN PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91706-3242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-338-0230
Provider Business Practice Location Address Fax Number:
626-962-8854
Provider Enumeration Date:
03/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  295035 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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