MEDICARE: BRIAN KEITH CONSTANTINE DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E3493	CA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	E3493	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480023833	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952349664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN KEITH CONSTANTINE DPM

Provider Business Mailing Address
First Line	:	18200 YORBA LINDA BLVD
Second Line	:	SUITE 401
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	82013 DOCTOR CARREON BLVD STE H
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-5832
Country	:	US
Telephone Number	:	760-610-8398
Fax Number	:	442-300-2925

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	04/16/2025

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Directions to “ BRIAN KEITH CONSTANTINE DPM” Practice Location

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