Individual provider Active NPI

Wilfredo Alejo, M.D.

  • Pediatrics Physician
  • Diamond Bar, CA
National Provider Identifier
1114990785
Registry record updated Oct 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A52629 Issued in CA
Practice address
1514 Valley Vista Dr
Diamond Bar, CA 91765
Phone
(909) 860-1144
NPI assigned
Feb 13, 2006
Last updated
Oct 14, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A52629 CA Primary

Addresses

Primary practice location

1514 Valley Vista Dr
Diamond Bar, CA 91765

Mailing address

1514 Valley Vista Dr
Diamond Bar, CA 91765-3929

Other practice location 1

420 W Rowland St
Covina, CA 91723-2943
Phone (626) 331-6411

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address walejo1373454@oc.providencedirect.org

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110106000849 CA Practitioner - Pediatric Medicine 5092904037 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Aug 1, 2015 Accepting new patients
Providence Medical Foundation CurrentSince Aug 1, 2015 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Emanate Health Medical Center Past Accepting new patients
St Jude Hospital Inc Past Accepting new patients
San Dimas Community Hospital, Inc. Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

1514 Valley Vista Dr
Diamond Bar, CA 91765
Phone (909) 560-1144

253 S Diamond Bar Blvd
Diamond Bar, CA 91765
Phone (909) 860-1144

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

4300 Rose Dr
Yorba Linda, CA 92886
Phone (714) 528-4211

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: walejo1373454@oc.providencedirect.org

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634169600000",
    "number": "1114990785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 VALLEY VISTA DR",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917653929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 VALLEY VISTA DR",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "91765",
            "telephone_number": "909-860-1144"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 W Rowland St",
            "address_purpose": "LOCATION",
            "city": "Covina",
            "state": "CA",
            "postal_code": "917232943",
            "country_code": "US",
            "telephone_number": "626-331-6411",
            "fax_number": "626-251-1560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALEJO",
        "first_name": "WILFREDO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A52629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "walejo1373454@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1514 Valley Vista Dr",
            "city": "Diamond Bar",
            "state": "CA",
            "country_code": "US",
            "postal_code": "91765",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Diamond Bar, CA

Sources for this page

Verify at the official NPI Registry.