NPIMap

Organization Active NPI

Jorge L. Geronimo, DDS Prof. Dental Corp.

  • Preferred Provider Organization
  • Riverside, CA
National Provider Identifier
1265809065
Registry record updated Jan 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
47897 Issued in CA
Legal business name
JORGE L. GERONIMO, DDS PROF. DENTAL CORP.
Practice address
9720 Magnolia Ave Suite #100
Riverside, CA 92503
Phone
(951) 696-3663
Fax
(951) 696-3887
NPI assigned
Aug 27, 2015
Last updated
Jan 3, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PACIFIC DENTAL CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 3, 2020

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

Authorized official

Name
Jorge Luis Geronimo, DDS
Title
Dentist
Phone
(714) 267-6400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 47897 CA Primary

Addresses

Primary practice location

9720 Magnolia Ave Suite #100
Riverside, CA 92503

Mailing address

9720 Magnolia Ave Suite 100
Riverside, CA 92503
Phone (951) 696-3663

National Provider Directory

National Provider Directory
Tax ID family
Jorge L Geronimo Ddsprofdental Cor5 organizations share this tax ID, including this one
Part of
Jorge L Geronimo Ddsprofdental Cor

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9720 Magnolia Ave
Ste 100
Riverside, CA 92503
Phone (951) 696-3663

NPI Registry JSON

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

{
    "created_epoch": "1440633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578009600000",
    "number": "1265809065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9720 MAGNOLIA AVE SUITE 100",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92503",
            "telephone_number": "951-696-3663",
            "fax_number": "951-696-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9720 MAGNOLIA AVE SUITE #100",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92503",
            "telephone_number": "951-696-3663",
            "fax_number": "951-696-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORGE L. GERONIMO, DDS PROF. DENTAL CORP.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PACIFIC DENTAL CLINIC",
        "enumeration_date": "2015-08-27",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A",
        "authorized_official_last_name": "GERONIMO",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "714-267-6400",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "47897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; 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.