Active NPI
Marcelo Freire, D.D.S.,PH.D., D.MED.
- Periodontics
- La Jolla, CA
National Provider Identifier
1013264357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 103604
- Practice address
- 4120 Capricorn LN
La Jolla, CA 92037-3498 - Phone
- (858) 200-1846
- NPI assigned
- Aug 6, 2012
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 103604 | CA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | DL11672 | MA |
Addresses
Primary practice location
4120 Capricorn LN
La Jolla, CA 92037-3498
Mailing address
4120 Capricorn LN
La Jolla, CA 92037-3498
Phone (858) 200-1846
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103604 | CA | MD | Periodontist |
| DL11672 | MA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669680000000",
"number": "1013264357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4120 CAPRICORN LN",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920373498",
"telephone_number": "858-200-1846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4120 CAPRICORN LN",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920373498",
"telephone_number": "858-200-1846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREIRE",
"first_name": "MARCELO",
"name_prefix": "Dr.",
"credential": "D.D.S.,PH.D., D.MED.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-06",
"last_updated": "2022-11-29",
"certification_date": "2022-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "103604",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MA",
"license": "DL11672",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.