Active NPI
Jerrod Paul Libonati, RD
- Registered Dietitian
- Las Vegas, NV
National Provider Identifier
1427639459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 39960-DI-0
- Practice address
- 280 S Decatur Blvd
Las Vegas, NV 89107-2936 - Phone
- (702) 759-0953
- NPI assigned
- Apr 20, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 911745 | CA | |
| Registered Dietitian | 133V00000X | 39960-DI-0 | NV | Primary |
Addresses
Primary practice location
280 S Decatur Blvd
Las Vegas, NV 89107-2936
Mailing address
280 S Decatur Blvd
Las Vegas, NV 89107-2936
Phone (702) 759-0953
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39960-DI-0 | Medicaid | NV | |
| 911745 | Medicaid | CA |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | diabeticsnacks@gmail.com | ||
| CONNECT URL | libonati@snhd.org |
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 |
|---|---|---|---|
| 911745 | CA | MD | Registered Dietitian |
| 39960-DI-0 | NV | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621036800000",
"number": "1427639459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "280 S DECATUR BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891072936",
"telephone_number": "702-759-0953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "280 S DECATUR BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891072936",
"telephone_number": "702-759-0953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBONATI",
"first_name": "JERROD",
"middle_name": "PAUL",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-20",
"last_updated": "2021-05-15",
"certification_date": "2021-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "911745",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NV",
"license": "39960-DI-0",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39960-DI-0",
"state": "NV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "911745",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "diabeticsnacks@gmail.com",
"affiliation": "N",
"address_1": "7905 Ryandale Cir Unit 201",
"city": "Las Vegas",
"state": "NV",
"country_code": "US",
"postal_code": "891452902",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "libonati@snhd.org",
"affiliation": "N",
"address_1": "280 S Decatur Blvd",
"city": "Las Vegas",
"state": "NV",
"country_code": "US",
"postal_code": "891072936",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.