Erwin Tamayo Carracedo, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40417 Issued in CA

Practice address

1331 Guerneville Rd
Suite G
Santa Rosa, CA 95403-4162

Phone

(650) 742-9092

Fax

(650) 742-9093

NPI assigned

Jun 7, 2007

Last updated

Mar 29, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Erwin T Carracedo DMD, Inc

  • Dentist
  • South San Francisco, CA
  • NPI 1619292117
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269820800000",
    "number": "1164625075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 CALLAN BLVD.",
            "address_2": "SUITE 100",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94080",
            "telephone_number": "650-742-9092",
            "fax_number": "650-742-9093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 GUERNEVILLE RD",
            "address_2": "SUITE G",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954034162",
            "telephone_number": "650-742-9092",
            "fax_number": "650-742-9093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRACEDO",
        "first_name": "ERWIN",
        "middle_name": "TAMAYO",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-07",
        "last_updated": "2010-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "40417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Carr
• Cathy Lee Carr, NONE
• Harry B Carr, M.D.
• Rachel Carr
• Christina M Carra, OT
• Anthony Carrasquillo, PT, DPT
• Paula Christine Carrasquillo, BIRTH DOULA
• Lizet Carreno-Acosta
• Erminio Carreno
• Jose Manuel Carreno

• General Practice Dentistry in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.