Healthcare Provider Details

I. General information

NPI: 1740284082
Provider Name (Legal Business Name): LUIS CONSTANTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MARTIN LUTHER KING AVE NE SUITE 210
ALBUQUERQUE NM
87102-3661
US

IV. Provider business mailing address

715 MARTIN LUTHER KING AVE NE SUITE 210
ALBUQUERQUE NM
87102-3661
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-1800
  • Fax: 505-248-1917
Mailing address:
  • Phone: 505-248-1800
  • Fax: 505-248-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2001-161
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2001-161
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: