Healthcare Provider Details

I. General information

NPI: 1043460587
Provider Name (Legal Business Name): MRS. CONSTANZA PATRICIA WHITWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS CONSTANZA PATRICIA BLOCK

II. Dates (important events)

Enumeration Date: 09/20/2008
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E ATHERTON ST STE 227B
LONG BEACH CA
90815-4018
US

IV. Provider business mailing address

2929 WESTMINSTER AVE UNIT 3191
SEAL BEACH CA
90740-9148
US

V. Phone/Fax

Practice location:
  • Phone: 562-386-5887
  • Fax:
Mailing address:
  • Phone: 562-386-5887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number77911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: