Costanza, Clint M.

Costanza, Clint M. is an individual health care provider with primary practice located at 9001 Summa Ave , Baton Rouge LA 70809-3726. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Costanza, Clint M. can be contacted via phone (225) 761-5200.

Contact Information

Primary practice address
9001 Summa Ave Baton Rouge LA 70809-3726
Phone: (225) 761-5200
Fax: (225) 761-5702
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA.200436 Louisiana

Profile Details

NPI number 1619266954
LBN Legal business name Costanza, Clint M.
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 6th, 2011
Last updated Apr 9th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619266954 NPPES
Mississippi MEDICAID 07908012
Mississippi MEDICAID 2141252

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