Healthcare Provider Details

I. General information

NPI: 1053246157
Provider Name (Legal Business Name): KATHERINE COSTANTINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1967 N VULCAN AVE
ENCINITAS CA
92024-1123
US

IV. Provider business mailing address

315 S COAST HIGHWAY 101 STE U258
ENCINITAS CA
92024-3543
US

V. Phone/Fax

Practice location:
  • Phone: 954-635-7353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: