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General NPI Number Information
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NPI Number | 1013996305
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Entity Type | Organization
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Legal Business Name | CONSTANCE C CORSINO MD INC
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12574 CENTRAL AVE
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-627-7433
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Fax | 909-627-8573
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Provider Business Mailing Address
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Address Line | 12574 CENTRAL AVE
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-627-7433
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Fax | 909-627-8573
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CONSTANCE CHAPPELL CORSINO
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Credential | MD
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Telephone | 909-627-7433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G25276
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License Number State | CA
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