Active NPI
Ana Dina Medrano
- Dental Assistant
- Pomona, CA
National Provider Identifier
1053934778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 60484
- Practice address
- 763 Rio Rancho Rd Ste 120
Pomona, CA 91766-7015 - Phone
- (909) 242-7989
- NPI assigned
- May 28, 2020
- 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 Assistant | 126800000X | 60484 | CA | Primary |
Addresses
Primary practice location
763 Rio Rancho Rd Ste 120
Pomona, CA 91766-7015
Mailing address
14595 Piedmont Dr
Moreno Valley, CA 92555-5740
Phone (951) 489-8120
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60484 | Medicaid | CA |
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 |
|---|---|---|---|
| 60484 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590624000000",
"number": "1053934778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14595 PIEDMONT DR",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925555740",
"telephone_number": "951-489-8120",
"fax_number": "951-247-1170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "763 RIO RANCHO RD STE 120",
"city": "POMONA",
"state": "CA",
"postal_code": "917667015",
"telephone_number": "909-242-7989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDRANO",
"first_name": "ANA",
"middle_name": "DINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-28",
"last_updated": "2020-05-28",
"certification_date": "2020-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "60484",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60484",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.