Individual
MR. CLINT M. COSTANZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
,PA
Contact information
Practice address
9001 SUMMA AVE, BATON ROUGE, LA 70809-3726
(225) 761-5200
(225) 761-5702
Mailing address
9001 SUMMA AVE, BATON ROUGE, LA 70809-3726
(225) 761-5200
(225) 761-5702
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA.200436
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07908012
—
MS
05
—
2141252
—
LA
Enumeration date
04/06/2011
Last updated
04/09/2013
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