Healthcare Provider Details

I. General information

NPI: 1124463286
Provider Name (Legal Business Name): JACQUELINE SANTUILE CONSTANTINO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4147 ADAMS AVE
SAN DIEGO CA
92116-2509
US

IV. Provider business mailing address

1111 6TH AVE STE 550 #463664
SAN DIEGO CA
92101-5211
US

V. Phone/Fax

Practice location:
  • Phone: 619-281-1932
  • Fax: 619-281-1947
Mailing address:
  • Phone: 619-333-8706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number22937
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number22937
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number22937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: