Active NPI
Monica Lara Cordoba, DMD
- Periodontics
- San Francisco, CA
National Provider Identifier
1154547966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 56928
- Practice address
- 490 Post St Ste 426
San Francisco, CA 94102-1411 - Phone
- (415) 362-2402
- Fax
- (415) 362-4134
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 56928 | CA | Primary |
Addresses
Primary practice location
490 Post St Ste 426
San Francisco, CA 94102-1411
Mailing address
490 Post St Ste 426
San Francisco, CA 94102-1411
Phone (415) 362-2402
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 |
|---|---|---|---|---|
| I20160120002905 | CA | Order and Referring Only - Dentist | 4688977036 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56928 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450137600000",
"number": "1154547966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "490 POST ST STE 426",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941021411",
"telephone_number": "415-362-2402",
"fax_number": "415-362-4134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "490 POST ST STE 426",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941021411",
"telephone_number": "415-362-2402",
"fax_number": "415-362-4134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARA CORDOBA",
"first_name": "MONICA",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-18",
"last_updated": "2015-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "56928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; 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.