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General NPI Number Information
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NPI Number | 1669036992
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Entity Type | Individual
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Provider Name | MARIANA THERESE CONSTABLE MOTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 04/22/2019
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Provider Practice Location Address
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Address Line | 1415 RIDGEBACK RD STE 2
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City | CHULA VISTA
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State | CA
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Zip | 91910-6983
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Country | US
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Telephone | 757-650-6636
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Fax |
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Provider Business Mailing Address
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Address Line | 4313 ECHO CT APT D
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City | LA MESA
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State | CA
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Zip | 91941-6642
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Country | US
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Telephone | 267-424-3099
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 19528
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License Number State | CA
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