Active NPI
Diana Alejandra Cevallos
- Pharmacist
- San Bernardino, CA
National Provider Identifier
1265211882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 88652
- Practice address
- 499 W Orange Show Rd
San Bernardino, CA 92408-2029 - Phone
- (909) 379-0003
- NPI assigned
- Sep 22, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 88652 | CA | Primary |
Addresses
Primary practice location
499 W Orange Show Rd
San Bernardino, CA 92408-2029
Mailing address
11204 Daylilly St
Fontana, CA 92337-6830
Phone (909) 262-4537
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
| License | State | Type | Specialty |
|---|---|---|---|
| 88652 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695340800000",
"number": "1265211882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11204 DAYLILLY ST",
"city": "FONTANA",
"state": "CA",
"postal_code": "923376830",
"telephone_number": "909-262-4537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "499 W ORANGE SHOW RD",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924082029",
"telephone_number": "909-379-0003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CEVALLOS",
"first_name": "DIANA",
"middle_name": "ALEJANDRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-22",
"last_updated": "2023-09-22",
"certification_date": "2023-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "88652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.