Individual provider Active NPI

David Cornejo Noriega

  • General Practice Dentistry
  • San Diego, CA
National Provider Identifier
1275648685
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
48159 Issued in CA
Practice address
1809 National Ave
San Diego, CA 92113-2113
Phone
(619) 515-2300
NPI assigned
Aug 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

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 48159 CA Primary

Addresses

Primary practice location

1809 National Ave
San Diego, CA 92113-2113

Mailing address

4411 Braeburn Rd
San Diego, CA 92116-2127

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230213000129 CA Practitioner - Other (Non-Physician) 0547491953 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc CurrentSince Nov 14, 2022 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Nov 14, 2022 Accepting new patients

Locations

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

Organizations & group practices 3

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": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1275648685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 BRAEBURN RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921162127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 NATIONAL AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921132113",
            "telephone_number": "619-515-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORIEGA",
        "first_name": "DAVID",
        "middle_name": "CORNEJO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "48159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.