Active NPI
Pedro A Avendano
- Dentist
- Hayward, CA
National Provider Identifier
1346571791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 58256
- Practice address
- 389 Gresel St
Hayward, CA 94544-7642 - Phone
- (510) 925-0188
- NPI assigned
- Jan 25, 2010
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 58256 | CA | Primary |
Addresses
Primary practice location
389 Gresel St
Hayward, CA 94544-7642
Mailing address
4012 Cedarhurst Dr Apt 108
Santa Maria, CA 93455-6403
Phone (510) 938-3846
Other practice location 1
4012 Cedarhurst Dr Apt 108
Santa Maria, CA 93455-6403
Phone (510) 938-3846
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58256 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729814400000",
"number": "1346571791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4012 CEDARHURST DR APT 108",
"city": "SANTA MARIA",
"state": "CA",
"postal_code": "934556403",
"telephone_number": "510-938-3846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "389 GRESEL ST",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945447642",
"telephone_number": "510-925-0188"
}
],
"practiceLocations": [
{
"address_1": "4012 Cedarhurst Dr Apt 108",
"address_purpose": "LOCATION",
"city": "Santa Maria",
"state": "CA",
"postal_code": "934556403",
"country_code": "US",
"telephone_number": "510-938-3846",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "AVENDANO",
"first_name": "PEDRO",
"middle_name": "A",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-25",
"last_updated": "2024-10-25",
"certification_date": "2024-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "58256",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hayward, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.