Individual provider Active NPI

Lizeth Dimas Sebastian

  • Clinical Social Worker
  • Costa Mesa, CA
National Provider Identifier
1043841737
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
88971 Issued in CA
Practice address
2801 Bristol St
Costa Mesa, CA 92626-5996
Phone
(714) 850-8408
NPI assigned
Jan 31, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 88971 CA Primary

Addresses

Primary practice location

2801 Bristol St
Costa Mesa, CA 92626-5996

Mailing address

2801 Bristol St
Costa Mesa, CA 92626-5996
Phone (714) 850-8408

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250415002150 CA Practitioner - Clinical Social Worker 6901321694 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10800 Magnolia Ave
Riverside, CA 92505-3043
Phone (951) 353-2000

2055 Kellogg Ave
Corona, CA 92879-3111
Phone (866) 984-7483

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
88971CAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Feb 1, 2025 Accepting new patients
Southern California Permanente Medical Group CurrentSince Feb 1, 2025 Accepting new patients
County of Orange CurrentSince Jul 10, 2022 Accepting new patients

Locations

2801 Bristol St
Costa Mesa, CA 92626
Phone (714) 850-8408

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1043841737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 BRISTOL ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265996",
            "telephone_number": "714-850-8408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 BRISTOL ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265996",
            "telephone_number": "714-850-8408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMAS SEBASTIAN",
        "first_name": "LIZETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-31",
        "last_updated": "2024-10-15",
        "certification_date": "2022-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "88971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

Verify at the official NPI Registry.