Active NPI
Alexis Leigh Carrillo-Holguin, RDHAP
- Advanced Practice Dental Therapist
- San Diego, CA
National Provider Identifier
1184286304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Dental Therapist
- License
- HAP741
- Practice address
- 501 W Broadway Ste 800
San Diego, CA 92101-3546 - Phone
- (619) 368-0053
- NPI assigned
- Jul 8, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Advanced Practice Dental Therapist | 125K00000X | HAP741 | CA | Primary |
Addresses
Primary practice location
501 W Broadway Ste 800
San Diego, CA 92101-3546
Mailing address
501 W Broadway Ste 800
San Diego, CA 92101-3546
Phone (619) 368-0053
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HAP741 | CA | MD | Advanced Practice Dental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562544000000",
"number": "1184286304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 W BROADWAY STE 800",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921013546",
"telephone_number": "619-368-0053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 W BROADWAY STE 800",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921013546",
"telephone_number": "619-368-0053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARRILLO-HOLGUIN",
"first_name": "ALEXIS",
"middle_name": "LEIGH",
"credential": "RDHAP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-08",
"last_updated": "2019-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "125K00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Dental Therapist",
"state": "CA",
"license": "HAP741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.