Active NPI
Joel Caraballo
- Dentist
- Culver City, CA
National Provider Identifier
1154767028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 106061
- Practice address
- 11962 Culver Dr
Culver City, CA 90230-6002 - Phone
- (787) 586-9559
- NPI assigned
- May 17, 2013
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 106061 | CA | Primary |
Addresses
Primary practice location
11962 Culver Dr
Culver City, CA 90230-6002
Mailing address
11962 Culver Dr
Culver City, CA 90230-6002
Phone (787) 586-9559
Other practice location 1
1608 Centinela Ave Ste 7
Inglewood, CA 90302-1061
Phone (310) 216-9600
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marina Adams DDS a Professional Dental Corporation | 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 and National Provider Directory roles.
-
- Dental Clinic/Center
- Inglewood, CA
- NPI 1528546801
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731369600000",
"number": "1154767028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11962 CULVER DR",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902306002",
"telephone_number": "787-586-9559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11962 CULVER DR",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902306002",
"telephone_number": "787-586-9559"
}
],
"practiceLocations": [
{
"address_1": "1608 Centinela Ave Ste 7",
"address_purpose": "LOCATION",
"city": "Inglewood",
"state": "CA",
"postal_code": "903021061",
"country_code": "US",
"telephone_number": "310-216-9600",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CARABALLO",
"first_name": "JOEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-05-17",
"last_updated": "2024-11-12",
"certification_date": "2024-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "106061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Culver City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.