Diego H Sevilla, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA13946 Issued in CA

Practice address

436 S Riverside Ave
Rialto, CA 92376-6523

Phone

(909) 877-8868

Fax

(909) 877-0008

NPI assigned

Dec 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• R Ruiz M D a Medical Corp

  • Primary Care Clinic/Center
  • Rialto, CA
  • NPI 1578599809
  Medicare reassignment
• Ruben Ruiz M D a Medical Corporation

  • Primary Care Clinic/Center
  • Ontario, CA
  • NPI 1043241821
  Medicare reassignment
• Javier R. Rios MD a Professional Corporation

  • Family Medicine Physician
  • Riverside, CA
  • NPI 1841023801
  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439510400000",
    "number": "1316008972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "436 S RIVERSIDE AVE",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923766523",
            "telephone_number": "909-877-8868",
            "fax_number": "909-877-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 S RIVERSIDE AVE",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923766523",
            "telephone_number": "909-877-8868",
            "fax_number": "909-877-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEVILLA",
        "first_name": "DIEGO",
        "middle_name": "H",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2015-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA13946",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL GROUP",
            "identifier": "GR0083640/GR0083641",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS MEDICAL",
            "identifier": "PA13946",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "ZZZ19972Z /ZZZ20075Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marleen Sebetich Reitsma
• Leandre Selyer, ACSW
• Anjali Sequeira, LMFT
• Serenitylife Therapy LCSW
• Seulki Yang, DDS., Inc
• Flora Mohamed F Shafiee, DPTS
• Samir B Shah, D.D.S.
• Ravindranath Vishnu Shahane, M.D.
• Matthew Eric Shamlin, LMFT
• Ahmed Esam Shehata

• Physician Assistant in Rialto, CA
• Providers in Rialto, CA by specialty
• Physician Assistant in California

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

Verify at the official NPI Registry.