Active NPI
Hector M Carmona, DDS
- Periodontics
- Montebello, CA
National Provider Identifier
1063935534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 104739
- Practice address
- 1712 W Beverly Blvd Ste 101
Montebello, CA 90640-3900 - Phone
- (323) 727-6944
- NPI assigned
- Jul 17, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 104739 | CA | Primary |
Addresses
Primary practice location
1712 W Beverly Blvd Ste 101
Montebello, CA 90640-3900
Mailing address
1712 W Beverly Blvd Ste 101
Montebello, CA 90640-3900
Phone (323) 727-6944
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 9, 2021 through Mar 9, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104739 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598400000000",
"number": "1063935534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1712 W BEVERLY BLVD STE 101",
"city": "MONTEBELLO",
"state": "CA",
"postal_code": "906403900",
"telephone_number": "323-727-6944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1712 W BEVERLY BLVD STE 101",
"city": "MONTEBELLO",
"state": "CA",
"postal_code": "906403900",
"telephone_number": "323-727-6944"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARMONA",
"first_name": "HECTOR",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-17",
"last_updated": "2020-08-26",
"certification_date": "2020-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "104739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montebello, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.