Active NPI
Fernando Verdugo, D.M.D., PHD
- Periodontics
- Altadena, CA
National Provider Identifier
1235345646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 53370
- Practice address
- 2028 Lake Ave
Altadena, CA 91001-2450 - Phone
- (626) 797-7551
- Fax
- (626) 797-0523
- NPI assigned
- May 15, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 53370 | CA | Primary |
Addresses
Primary practice location
2028 Lake Ave
Altadena, CA 91001-2450
Mailing address
6344 Primrose Ave
Los Angeles, CA 90068-2886
Phone (310) 709-0193
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140626001485 | CA | Practitioner - Oral Surgery | 0840415220 | Practice locations: Altadena, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53370 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450051200000",
"number": "1235345646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6344 PRIMROSE AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900682886",
"telephone_number": "310-709-0193",
"fax_number": "626-797-7551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2028 LAKE AVE",
"city": "ALTADENA",
"state": "CA",
"postal_code": "910012450",
"telephone_number": "626-797-7551",
"fax_number": "626-797-0523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VERDUGO",
"first_name": "FERNANDO",
"name_prefix": "Dr.",
"credential": "D.M.D., PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-15",
"last_updated": "2015-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "53370",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Altadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; 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.