Active NPI
Stephen Mark Puentes, MD
- Infectious Disease Physician
- Los Angeles, CA
National Provider Identifier
1336295997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Infectious Disease Physician
- License
- G63475
- Practice address
- 5850 S Main St
Room 1127
Los Angeles, CA 90003-1215 - Phone
- (323) 846-4219
- Fax
- (323) 238-0210
- NPI assigned
- Jan 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Infectious Disease Physician | 207RI0200X | G63475 | CA | Primary |
Addresses
Primary practice location
5850 S Main St
Room 1127
Los Angeles, CA 90003-1215
Mailing address
8902 Woodman Ave
Arleta, CA 91331-6401
Phone (818) 830-7033
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FHC70769F | Medicaid | CA | |
| 952662606 | Other | CA | TAX ID EPDB GROUP |
| FHC70468F | Medicaid | CA | |
| G063475 | Other | CA | MEDICAL LICENSE |
| FHC 11866 F | Medicaid | CA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63475 | CA | MD | Pharmacist |
| G63475 | CA | MD | Infectious Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269388800000",
"number": "1336295997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8902 WOODMAN AVE",
"city": "ARLETA",
"state": "CA",
"postal_code": "913316401",
"telephone_number": "818-830-7033",
"fax_number": "818-830-7280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5850 S MAIN ST",
"address_2": "ROOM 1127",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900031215",
"telephone_number": "323-846-4219",
"fax_number": "323-238-0210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUENTES",
"first_name": "STEPHEN",
"middle_name": "MARK",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2010-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "207RI0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Infectious Disease",
"state": "CA",
"license": "G63475",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FHC70769F",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID EPDB GROUP",
"identifier": "952662606",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FHC70468F",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "G063475",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FHC 11866 F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.