Active NPI
Mary Ann Maravillas, D.D.S.
- Dentist
- Berkeley, CA
National Provider Identifier
1083051981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 62001
- Practice address
- 1100 Eastshore Hwy
Berkeley, CA 94710-1002 - Phone
- (510) 559-9971
- NPI assigned
- May 31, 2013
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 62001 | CA | Primary |
Addresses
Primary practice location
1100 Eastshore Hwy
Berkeley, CA 94710-1002
Mailing address
1100 Eastshore Hwy
Berkeley, CA 94710-1002
Phone (510) 559-9971
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: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151118002759 | CA | Order and Referring Only - Dentist | 7810297173 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454284800000",
"number": "1083051981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 EASTSHORE HWY",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947101002",
"telephone_number": "510-559-9971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 EASTSHORE HWY",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947101002",
"telephone_number": "510-559-9971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARAVILLAS",
"first_name": "MARY ANN",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-31",
"last_updated": "2016-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.