Individual provider Active NPI

Lillian R Liberto, DDS

  • General Practice Dentistry
  • San Diego, CA
National Provider Identifier
1245350982
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
38905 Issued in CA
Practice address
10789 Tierrasanta Blvd Ste 110
San Diego, CA 92124-2613
Phone
(858) 565-0212
NPI assigned
Mar 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 38905 CA Primary

Addresses

Primary practice location

10789 Tierrasanta Blvd Ste 110
San Diego, CA 92124-2613

Mailing address

9452 Hito CT
San Diego, CA 92129-4914
Phone (619) 602-9438

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

LicenseStateTypeSpecialty
38905CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
D.Douglas Cassat, DDS.Apc Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245350982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9452 HITO CT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921294914",
            "telephone_number": "619-602-9438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10789 TIERRASANTA BLVD STE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921242613",
            "telephone_number": "858-565-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBERTO",
        "first_name": "LILLIAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "38905",
            "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, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.