Active NPI
Mariana Therese Constable, MOTR/L
- Occupational Therapist
- Chula Vista, CA
National Provider Identifier
1669036992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 19528
- Practice address
- 1415 Ridgeback Rd Ste 2
Chula Vista, CA 91910-6983 - Phone
- (757) 650-6636
- NPI assigned
- Apr 22, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 19528 | CA | Primary |
Addresses
Primary practice location
1415 Ridgeback Rd Ste 2
Chula Vista, CA 91910-6983
Mailing address
4313 Echo CT Apt D
La Mesa, CA 91941-6642
Phone (267) 424-3099
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2674243099 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19528 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555891200000",
"number": "1669036992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4313 ECHO CT APT D",
"city": "LA MESA",
"state": "CA",
"postal_code": "919416642",
"telephone_number": "267-424-3099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1415 RIDGEBACK RD STE 2",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919106983",
"telephone_number": "757-650-6636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONSTABLE",
"first_name": "MARIANA",
"middle_name": "THERESE",
"credential": "MOTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-22",
"last_updated": "2019-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "19528",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2674243099",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.