Healthcare Provider Details

I. General information

NPI: 1184818775
Provider Name (Legal Business Name): CHRISSA A CONSTANTINE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST G-2
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

8 PASILLO CHICO
SANTA FE NM
87508-9577
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-7199
  • Fax:
Mailing address:
  • Phone: 505-699-7199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4432
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: