MEDICARE: DR. CONSTANCE R BOUVIER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1147289	CA
2	103TC0700X	Clinical Psychologist	PSY14709	CA

General Provider Information

NPI Number	:	1134156037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONSTANCE R BOUVIER PHD

Provider Business Mailing Address
First Line	:	4682 WARNER AVE UNIT A110
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-3976
Country	:	US
Telephone Number	:	714-904-0874
Fax Number	:

Provider Business Practice Location Address
First Line	:	16152 BEACH BLVD STE 269
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3864
Country	:	US
Telephone Number	:	714-904-0874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	05/05/2026

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