Active NPI
Desiree Rose Gatbonton, RDH
- Dental Hygienist
- San Diego, CA
National Provider Identifier
1013763176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 0402208663
- Practice address
- 2310 Craven St
San Diego, CA 92136-5596 - Phone
- (619) 556-9984
- NPI assigned
- Apr 29, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 0402208663 | VA | Primary |
Addresses
Primary practice location
2310 Craven St
San Diego, CA 92136-5596
Mailing address
290 2ND Ave Apt 4
Chula Vista, CA 91910-2960
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 |
|---|---|---|---|
| 0402208663 | VA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714348800000",
"number": "1013763176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "290 2ND AVE APT 4",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919102960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2310 CRAVEN ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921365596",
"telephone_number": "619-556-9984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GATBONTON",
"first_name": "DESIREE",
"middle_name": "ROSE",
"name_prefix": "Mrs.",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-29",
"last_updated": "2024-04-29",
"certification_date": "2024-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "VA",
"license": "0402208663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.