Individual provider Active NPI

Peter Paul Feliciano, D.M.D.

  • General Practice Dentistry
  • Moreno Valley, CA
National Provider Identifier
1174570469
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
37104 Issued in CA
Practice address
13373 Perris Blvd
Moreno Valley, CA 92553-4206
Phone
(951) 485-2860
Fax
(951) 485-2862
NPI assigned
May 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 37104 CA Primary

Addresses

Primary practice location

13373 Perris Blvd
Moreno Valley, CA 92553-4206

Mailing address

13373 Perris Blvd. Suite D-306
Moreno Valley, CA 92553-4208
Phone (951) 485-2860

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160302001259 CA Order and Referring Only - DentistPractitioner - Dentist 6709182603

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
37104CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Peter R. Feliciano, D.M.D., Inc General Practice 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.

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174570469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13373 PERRIS BLVD. SUITE D-306",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925534208",
            "telephone_number": "951-485-2860",
            "fax_number": "951-485-2862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13373 PERRIS BLVD",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925534206",
            "telephone_number": "951-485-2860",
            "fax_number": "951-485-2862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELICIANO",
        "first_name": "PETER",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "37104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

Verify at the official NPI Registry.