Healthcare Provider Details

I. General information

NPI: 1013996305
Provider Name (Legal Business Name): CONSTANCE C CORSINO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12574 CENTRAL AVE
CHINO CA
91710
US

IV. Provider business mailing address

12574 CENTRAL AVE
CHINO CA
91710
US

V. Phone/Fax

Practice location:
  • Phone: 909-627-7433
  • Fax: 909-627-8573
Mailing address:
  • Phone: 909-627-7433
  • Fax: 909-627-8573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG25276
License Number StateCA

VIII. Authorized Official

Name: DR. CONSTANCE CHAPPELL CORSINO
Title or Position: PRESIDENT
Credential: MD
Phone: 909-627-7433