Mauricio Fonrodona, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

49314 Issued in CA

Practice address

6650 Reseda Blvd
Ste 112
Reseda, CA 91335-5340

Phone

(818) 609-7525

Fax

(818) 609-7569

NPI assigned

Sep 20, 2006

Last updated

Sep 9, 2022By the provider in NPPES

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1194822197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6650 RESEDA BLVD",
            "address_2": "STE 112",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913355340",
            "telephone_number": "818-609-7525",
            "fax_number": "818-609-7569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6650 RESEDA BLVD",
            "address_2": "STE 112",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913355340",
            "telephone_number": "818-609-7525",
            "fax_number": "818-609-7569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONRODONA",
        "first_name": "MAURICIO",
        "name_prefix": "Mr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "49314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Forever Hospice Care Inc
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• General Practice Dentistry in Reseda, CA
• Providers in Reseda, 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, 2022; 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.