Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 100929 | CA |
NPI | 1275725087 |
---|---|
Provider Name | Dr. Daniel Constandse |
First Address | Irvine, CA 92620-1921 |
Second Address | Irvine, CA 92620-1921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2007 |
Last Update Date | 06/12/2021 |