DR. CARRIE LEE COSTANTINI (NPI# 1467584979) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467584979 |
| Entity Type | Individual |
| Full Name | DR. CARRIE LEE COSTANTINI |
| Other Name | CARRIE LEE JOHNSON WALLER |
| Credential | M.D. |
| Practice Address |
501 Washington St Ste 508 San Diego CA 92103-2238 |
| Mailing Address |
10790 Rancho Bernardo Rd San Diego CA 92127-5705 |
| Practice Telephone | 6198494469 |
| Practice Fax Number | 6198491547 |
| Mailing Telephone | 6198494469 |
| Mailing Fax Number | 6198491547 |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2020-01-02 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | A93710 | CA | Allopathic & Osteopathic Physicians |
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
A93710 | CA | Allopathic & Osteopathic Physicians |
| N | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
A93710 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
501 WASHINGTON ST STE 508 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92103-2238 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598732604 | Houman Dahi | Internal Medicine | 501 Washington St Ste 508, San Diego, CA 92103-2231 | 2006-03-07 |
| 1407116627 | Aditya Sarvaria | Internal Medicine | 501 Washington St Ste 508, San Diego, CA 92103-2238 | 2012-05-22 |
| 1841589694 | Gregory Preclaro Ranches | Internal Medicine | 501 Washington St Ste 508, San Diego, CA 92103 | 2011-04-01 |
| 1801020334 | Kathryn B Bollin | Internal Medicine | 501 Washington St Ste 508, San Diego, CA 92103-2238 | 2009-05-12 |
| 1437211372 | Marin F Xavier | Internal Medicine | 501 Washington St Ste 508, San Diego, CA 92103-2238 | 2006-12-15 |
| 1730193996 | Joseph Robert Resnikoff | Internal Medicine | 501 Washington St Ste 508, San Diego, CA 92103-2231 | 2006-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174140057 | Carmel Agdeppa | Acupuncturist | Chiropractique, 813 West Washington St., San Diego, CA 92103 | 2020-06-26 |
| 1568082717 | Salina Ann Bambic | Social Worker | 302 Washington Street Suite 420, San Diego, CA 92103 | 2020-04-17 |
| 1467099432 | Lina Hong | Behavior Technician | 3731 6th Ave. Suite 100, San Diego, Ca 92103, San Diego, CA 92103 | 2019-12-09 |
| 1154964567 | Rodger Stacy Questin, Psychologist P.C. | Psychologist | 440 Upas St Apt 402, San Diego, CA 92103 | 2019-10-18 |
| 1932740388 | Grace Tong-ventura | Pharmacist | 200 W. Arbor Drive, #8765, Suite 1-317, San Diego, CA 92103 | 2019-10-07 |
| 1306490453 | Genevieve Cheung | Pharmacist | 200 W Arbor Dr #8765, Department of Pharmacy, San Diego, CA 92103 | 2019-07-26 |
| 1801356837 | Marika Doviak | Acupuncturist | 2370 Hickory St, San Diego, CA 92103 | 2019-03-25 |
| 1982185070 | Tyler Lewis Roberts | Counselor | 4303 3rd Ave, San Diego, CA 92103 | 2018-08-27 |
| 1689151284 | Tori Breanne Blackwell | Occupational Therapist | 3731-a 6th Avenue, San Diego, CA 92103 | 2018-07-26 |
| 1952892614 | Pacific Bay Recovery Inc | Substance Abuse Rehabilitation Facility | 4095 Jackdaw St, San Diego, CA 92103 | 2018-05-29 |
| Find all providers in zip 92103 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770926743 | Joseph Caperna Md A Professional Corporation | Internal Medicine | 2333 First Ave, Suite 104, San Diego, CA 92101-1538 | 2013-04-09 |
| 1407142409 | Isan Chen | Internal Medicine | 9393 Towne Centre Dr, Suite 200, San Diego, CA 92121-3070 | 2011-06-28 |
| 1376607036 | Annette Von Drygalski | Internal Medicine | 9333 Genesee Ave Ste 310, San Diego, CA 92121-2111 | 2006-12-20 |
| 1477628634 | Steven Edward Kossman | Internal Medicine | 5555 Reservoir Dr Ste 306, San Diego, CA 92120-5178 | 2006-11-22 |
| 1649360595 | Wendy Jo Levin | Internal Medicine | 10646 Science Center Dr, Cb10, San Diego, CA 92121-1150 | 2006-10-13 |
| 1851306526 | Saeeda Kirmani | Internal Medicine | 3350 La Jolla Village Dr # 111e, San Diego, CA 92161-0002 | 2006-07-30 |
| 1699721035 | Joel M Lamon | Internal Medicine | 16918 Dove Canyon Rd, Suite 103, San Diego, CA 92127-3445 | 2006-05-26 |
| 1629046925 | Medical Oncology Associates of San Diego A Medical Group Inc | Internal Medicine | 3075 Health Center Dr, Suite 102, San Diego, CA 92123-2773 | 2006-03-10 |
| 1831162627 | Steven G Eisenberg | Internal Medicine | 16918 Dove Canyon Rd Ste 103, San Diego, CA 92127-3455 | 2006-02-10 |
| 1699772756 | Raymond C Heung | Internal Medicine | 5222 Balboa Ave, Ste 33, San Diego, CA 92117-6953 | 2005-07-05 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.