Individual provider Active NPI

Decerie Baculi Dayag, MD

  • Internal Medicine Physician
  • Upland, CA
National Provider Identifier
1336660901
Registry record updated Dec 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A169662 Issued in CA
Practice address
811 E 11TH St Ste 208
Upland, CA 91786-4872
Phone
(909) 985-0883
Fax
(909) 985-5762
NPI assigned
Jul 4, 2017
Last updated
Dec 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A169662 CA Primary

Addresses

Primary practice location

811 E 11TH St Ste 208
Upland, CA 91786-4872

Mailing address

16465 Sierra Lakes Pkwy Ste 115
Fontana, CA 92336-1242
Phone (909) 823-8000

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260213003781 CA Practitioner - Internal Medicine 6507283256 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

16465 Sierra Lakes Pkwy
Fontana, CA 92336-1242

16854 Ivy Ave
Suite a
Fontana, CA 92335-1504

2855 Foothill Blvd Unit
G204
LA Verne, CA 91750-3175

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A169662CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Namita Mohideen MD Inc Multi-Specialty CurrentSince Dec 13, 2025 Accepting new patients
Golden State Primary Care Inc Multi-Specialty Past Accepting new patients

Locations

16465 Sierra Lakes Pkwy
Ste 115
Fontana, CA 92336
Phone (909) 823-8000

16854 Ivy Ave
Ste A
Fontana, CA 92335
Phone (909) 791-1000

811 E 11th St
Ste 208
Upland, CA 91786
Phone (909) 629-5540

15237 Eleventh St
Ste C
Victorville, CA 92395
Phone (760) 493-9300

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1499126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766016000000",
    "number": "1336660901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16465 SIERRA LAKES PKWY STE 115",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923361242",
            "telephone_number": "909-823-8000",
            "fax_number": "909-823-8088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 E 11TH ST STE 208",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864872",
            "telephone_number": "909-985-0883",
            "fax_number": "909-985-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAYAG",
        "first_name": "DECERIE",
        "middle_name": "BACULI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-04",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A169662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.