Individual provider Active NPI

Daniel Luis Stuardo, DMD

  • General Practice Dentistry
  • San Diego, CA
National Provider Identifier
1356992069
Registry record updated Sep 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DDS104402 Issued in CA
Practice address
3900 Fifth Ave Ste 270
San Diego, CA 92103-3137
Phone
(619) 810-1864
NPI assigned
Sep 24, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2019

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 DDS104402 CA Primary

Addresses

Primary practice location

3900 Fifth Ave Ste 270
San Diego, CA 92103-3137

Mailing address

4243 Bonita Rd Apt 20
Bonita, CA 91902-1430
Phone (619) 925-1985

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

LicenseStateTypeSpecialty
DDS104402CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569283200000",
    "number": "1356992069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4243 BONITA RD APT 20",
            "city": "BONITA",
            "state": "CA",
            "postal_code": "919021430",
            "telephone_number": "619-925-1985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 FIFTH AVE STE 270",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033137",
            "telephone_number": "619-810-1864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUARDO",
        "first_name": "DANIEL",
        "middle_name": "LUIS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-24",
        "last_updated": "2019-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS104402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.