Healthcare Provider Details

I. General information

NPI: 1811613946
Provider Name (Legal Business Name): JASMINE CONSTANZO, D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SOQUEL AVE STE 350
SANTA CRUZ CA
95062-2320
US

IV. Provider business mailing address

531B DUFOUR ST
SANTA CRUZ CA
95060-5345
US

V. Phone/Fax

Practice location:
  • Phone: 831-334-9931
  • Fax:
Mailing address:
  • Phone: 415-706-2734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASMINE CONSTANZO
Title or Position: DOCTOR
Credential: DO
Phone: 415-706-2734