Active NPI
Octavio Frias Penaloza, PA-C
- Physician Assistant
- Yuba City, CA
National Provider Identifier
1154332492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA12685
- Practice address
- 1531 Plumas CT Ste B
Yuba City, CA 95991-2966 - Phone
- (530) 751-4900
- Fax
- (530) 751-4901
- NPI assigned
- Aug 11, 2006
- Last updated
- May 10, 2019
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA12685 | CA | Primary |
Addresses
Primary practice location
1531 Plumas CT Ste B
Yuba City, CA 95991-2966
Mailing address
PO Box 3067
Yuba City, CA 95992-3067
Phone (530) 751-4784
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CB230779 | Other | CA | MEDICARE PTAN NUMBER |
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12685 | CA | MD | Speech-Language Pathologist |
| PA12685 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| California Emergency Physicians Medical Group | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Visalia, CA
- NPI 1699721027
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557446400000",
"number": "1154332492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3067",
"city": "YUBA CITY",
"state": "CA",
"postal_code": "959923067",
"telephone_number": "530-751-4784",
"fax_number": "530-751-4906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1531 PLUMAS CT STE B",
"city": "YUBA CITY",
"state": "CA",
"postal_code": "959912966",
"telephone_number": "530-751-4900",
"fax_number": "530-751-4901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENALOZA",
"first_name": "OCTAVIO",
"middle_name": "FRIAS",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2019-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA12685",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN NUMBER",
"identifier": "CB230779",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yuba City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.