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Individual

MR. JAMES D COSTANTINO III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
4340 N INTERSTATE AVE, PORTLAND, OR 97217-3211
(888) 227-3312
Mailing address
PO BOX 3229, PORTLAND, OR 97208-3229
(888) 227-3312

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
54917
CA
363A00000X
Physician Assistant
PA210140
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
54917
CALIFORNIA PHYSICIAN ASSISTANT BOARD
CA
Enumeration date
09/26/2017
Last updated
12/07/2022
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