Active NPI
Dimitry Konstantinov
- Athletic Trainer
- Henderson, NV
National Provider Identifier
1316491509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0506423
- Practice address
- 1001 Coronado Center Dr
Henderson, NV 89052-3950 - Phone
- (702) 799-6800
- NPI assigned
- Aug 5, 2016
- Last updated
- Aug 5, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0506423 | NV | Primary |
Addresses
Primary practice location
1001 Coronado Center Dr
Henderson, NV 89052-3950
Mailing address
10004 Perceval St
Las Vegas, NV 89183-6984
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 |
|---|---|---|---|
| 0506423 | NV | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470355200000",
"number": "1316491509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10004 PERCEVAL ST",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891836984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 CORONADO CENTER DR",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890523950",
"telephone_number": "702-799-6800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONSTANTINOV",
"first_name": "DIMITRY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-08-05",
"last_updated": "2016-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NV",
"license": "0506423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.