Individual provider Active NPI

Nathaly Maria Coromoto Sweeney, M.D.

  • Neonatal-Perinatal Medicine Physician
  • La Jolla, CA
National Provider Identifier
1164572632
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
A110761 Issued in CA
Practice address
9300 Campus Point Dr # Mc7774
La Jolla, CA 92037-1300
Phone
(619) 543-3759
Fax
(619) 543-3812
NPI assigned
Jan 10, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X P20264 MD
Pediatric Cardiology Physician 2080P0202X A110761 CA
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X D67515 MD
Neonatal-Perinatal Medicine Physician 2080N0001X A110761 CA Primary

Addresses

Primary practice location

9300 Campus Point Dr # Mc7774
La Jolla, CA 92037-1300

Mailing address

9300 Campus Point Dr # Mc7774
La Jolla, CA 92037-1300
Phone (619) 543-3759

Other practice location 1

3020 Childrens Way
San Diego, CA 92123-4223
Phone (858) 576-1700

Other identifiers 1

IdentifierTypeStateIssuer
018764000MedicaidMD

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
I20160729002276 CA Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 7012084908

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P20264MDMDPediatrics Physician
A110761CAMDPediatric Cardiology Physician
D67515MDMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rady Children'S Hospital San Diego Past Accepting new patients
Lucile Salter Packard Children'S Hospital at Stanford Past Accepting new patients
Regents of the University of California Past Accepting new patients
Marilyn Kaufhold, M.D., a Medical Corporation Past Accepting new patients
Palomar Health Past Accepting new patients

Organizations & group practices 5

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": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1164572632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9300 CAMPUS POINT DR # MC7774",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371300",
            "telephone_number": "619-543-3759",
            "fax_number": "619-543-3812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 CAMPUS POINT DR # MC7774",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371300",
            "telephone_number": "619-543-3759",
            "fax_number": "619-543-3812"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3020 Childrens Way",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921234223",
            "country_code": "US",
            "telephone_number": "858-576-1700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SWEENEY",
        "first_name": "NATHALY",
        "middle_name": "MARIA COROMOTO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "P20264",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "CA",
            "license": "A110761",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "MD",
            "license": "D67515",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CA",
            "license": "A110761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018764000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.