Healthcare Provider Details

I. General information

NPI: 1275456840
Provider Name (Legal Business Name): LUMINA PSYCHIATRIC NURSING A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 09/04/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 RIO SAN DIEGO DR STE 800
SAN DIEGO CA
92108-1642
US

IV. Provider business mailing address

8880 RIO SAN DIEGO DR STE 800
SAN DIEGO CA
92108-1642
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE CONSTANTINO
Title or Position: PRESIDENT
Credential: DNP, PMHNP-BC, AGNP
Phone: 714-306-2778