Individual provider Active NPI

Pariksha Gunnala, DDS

  • Dentist
  • Camarillo, CA
National Provider Identifier
1124337126
Registry record updated Aug 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
102333 Issued in CA
Practice address
4900 Verdugo Way
Suite a
Camarillo, CA 93012
Phone
(805) 484-7277
NPI assigned
Sep 25, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 25738 TX
Dentist 122300000X 102333 CA Primary

Addresses

Primary practice location

4900 Verdugo Way
Suite a
Camarillo, CA 93012

Mailing address

1651 Falling Star Ave
Westlake Village, CA 91362-5282
Phone (602) 405-6195

Other practice location 1

2246 Jacksboro Hwy Ste 112
Fort Worth, TX 76114-2363
Phone (817) 529-1799

Other identifiers 1

IdentifierTypeStateIssuer
1124337126MedicaidTX

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181017003798 CA Order and Referring Only - DentistPractitioner - Dentist 8729330881

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
102333CAMDDentist
25738TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Bob Jing DDS PA General Practice Past Accepting new patients
Workings and Lambridis Dental Corporation General Practice Past Accepting new patients

Organizations & group practices 2

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": "1285372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533168000000",
    "number": "1124337126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1651 FALLING STAR AVE",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913625282",
            "telephone_number": "602-405-6195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 VERDUGO WAY",
            "address_2": "SUITE A",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "93012",
            "telephone_number": "805-484-7277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2246 Jacksboro Hwy Ste 112",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761142363",
            "country_code": "US",
            "telephone_number": "817-529-1799",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUNNALA",
        "first_name": "PARIKSHA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-25",
        "last_updated": "2018-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "25738",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "102333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124337126",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camarillo, CA

Sources for this page

Verify at the official NPI Registry.