Mirtha Johanna Yabar Tello I, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

110045 Issued in CA

Practice address

121 Barboza St
Mendota, CA 93640-1901

Phone

(800) 492-4227

NPI assigned

Oct 23, 2024

Last updated

Oct 23, 2024By the provider in NPPES

Sex

Female

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

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

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: mirta.yabar.tello.1@17661.direct.athenahealth.com

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

{
    "created_epoch": "1729641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1194546838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18465 BERRY RD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925088868",
            "telephone_number": "951-201-1792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 BARBOZA ST",
            "city": "MENDOTA",
            "state": "CA",
            "postal_code": "936401901",
            "telephone_number": "800-492-4227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YABAR TELLO",
        "first_name": "MIRTHA",
        "middle_name": "JOHANNA",
        "name_prefix": "Dr.",
        "name_suffix": "I",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-23",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "110045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• United Health Centers of the San Joaquin Valley
• United Health Centers of the San Joaquin Valley
• Maria De Jesus Verdugo Lopez, LCSW
• Westside Medical Group of Mendota Inc.
• Brandon Wong, PA-C

• Dentist in Mendota, CA
• Providers in Mendota, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; 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.