Fernando De la Pena, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

43934 Issued in CA

Practice address

2701 Beverly Blvd
Los Angeles, CA 90057-1007

Phone

(213) 389-6211

Fax

(213) 389-4168

NPI assigned

Mar 5, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 12, 2015 through Nov 12, 2027

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 and National Provider Directory roles.

• Dr. Fernando de la Pena Dental Corporation

  • General Practice Dentistry
  • Los Angeles, CA
  • NPI 1740319094
  NPD (past) Authorized official

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220918400000",
    "number": "1174652135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 GLENMANOR PL",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900391711",
            "telephone_number": "323-660-8646",
            "fax_number": "323-660-8646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 BEVERLY BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900571007",
            "telephone_number": "213-389-6211",
            "fax_number": "213-389-4168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA PENA",
        "first_name": "FERNANDO",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2008-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "43934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL PROVIDER NO.",
            "identifier": "B43934-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aaron Rodrigo De la O
• Phillip Michael De la O
• Edith De la Paz
• Rosa De la Paz
• De la Pena Eye Clinic, a Medical Group, Inc
• Monique Diaz De la Pena
• Elia De la Riva
• Marisol A De la Rocha
• De la Rosa Family Vision, PC
• Angelo De la Rosa, MD

• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, 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 Sep 9, 2008; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.