Ernesto Licon, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

A160205 Issued in CA

Practice address

101 The City Dr S
Orange, CA 92868-3201

Phone

(714) 880-2911

NPI assigned

Jun 6, 2017

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Regents of the University of California

  • Obstetrics & Gynecology Physician
  • Orange, CA
  • NPI 1356304034
  Medicare reassignment NPD
• University of California Irvine

  • Federally Qualified Health Center (FQHC)
  • Anaheim, CA
  • NPI 1598790529
  Medicare reassignment NPD
• Valley Obstetrics & Gynecology Medical Group, Inc.

  • Obstetrics & Gynecology Physician
  • Colton, CA
  • NPI 1144304817
  Medicare reassignment NPD
• University of California Irvine

  • Pharmacy
  • Irvine, CA
  • NPI 1669344339
  NPD
• San Gabriel Valley Perinatal Medical Group, Inc

  • Maternal & Fetal Medicine Physician
  • West Covina, CA
  • NPI 1154371623
  NPD (past)
• University of California Irvine

  • Infusion Therapy Clinic/Center
  • Irvine, CA
  • NPI 1417027475
  NPD (past)
• University of California Irvine

  • General Acute Care Hospital
  • Orange, CA
  • NPI 1689608150
  NPD (past)

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1194254896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S MANCHESTER AVE STE 300",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683219",
            "telephone_number": "714-456-2986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-880-2911"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 N. State St.",
            "address_2": "IPT C3F107",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "90033",
            "country_code": "US",
            "telephone_number": "915-731-4713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICON",
        "first_name": "ERNESTO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-06",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A160205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaelin Carole Liccardo
• Jeanne Mary Lichman, PH.D.
• Alicia Beth Lichvar, PHARMD
• Beatriz Licon
• Elise Licon
• Desiree a Lie, MD
• Valeri Liebig, MA, MFT INTERN
• Steven Liem
• Li-Chang Lien, MD
• Blair Lieu

• Obstetrics & Gynecology Physician in Orange, CA
• Providers in Orange, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.