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General NPI Number Information
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NPI Number | 1053243279
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Entity Type | Individual
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Provider Name | JOHN COSTANZO
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Gender | Male
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 650 S GRANDRIDGE AVE
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City | MONTEREY PARK
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State | CA
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Zip | 91754-3921
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Country | US
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Telephone | 626-570-6249
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Fax |
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Provider Business Mailing Address
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Address Line | 2479 VISTA LAGUNA TER
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City | PASADENA
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State | CA
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Zip | 91103-1022
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Country | US
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Telephone | 323-804-1269
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 240204609
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License Number State | CA
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