Individual provider Active NPI

Constance M Haddad, FNP

  • Family Nurse Practitioner
  • Rancho Cucamonga, CA
National Provider Identifier
1811288665
Registry record updated Jun 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
346691 Issued in CA
Practice address
8360 Red Oak St
Suite 103
Rancho Cucamonga, CA 91730-0607
Phone
(909) 980-1946
Fax
(909) 980-1625
NPI assigned
Apr 27, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 346691 CA Primary

Addresses

Primary practice location

8360 Red Oak St
Suite 103
Rancho Cucamonga, CA 91730-0607

Mailing address

8360 Red Oak St
Suite 103
Rancho Cucamonga, CA 91730-0607
Phone (909) 980-1946

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)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11400CAMDAddiction (Substance Use Disorder) Counselor
346691CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
James R Brown MD Inc CurrentSince Jul 1, 2017 Accepting new patients
San Antonio Regional Hospital PastSince Sep 1, 2016 Accepting new patients

Locations

8360 Red Oak St
Ste 103
Rch Cucamonga, CA 91730
Phone (909) 980-1946

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339459200000",
    "number": "1811288665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8360 RED OAK ST",
            "address_2": "SUITE 103",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300607",
            "telephone_number": "909-980-1946",
            "fax_number": "909-980-1625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8360 RED OAK ST",
            "address_2": "SUITE 103",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300607",
            "telephone_number": "909-980-1946",
            "fax_number": "909-980-1625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDAD",
        "first_name": "CONSTANCE",
        "middle_name": "M",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-27",
        "last_updated": "2012-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "346691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.