Active NPI
Erica Berenice Licea, RDA ORTHO ASSISTANT
- Dental Assistant
- Rialto, CA
National Provider Identifier
1376002287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 66604
- Practice address
- 1342 W la Gloria Dr
Rialto, CA 92377-4466 - Phone
- (951) 465-9162
- NPI assigned
- Mar 19, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 66604 | CA | Primary |
Addresses
Primary practice location
1342 W la Gloria Dr
Rialto, CA 92377-4466
Mailing address
1342 W la Gloria Dr
Rialto, CA 92377-4466
Phone (951) 465-9162
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 66604 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66604 | CA | MD | Dental Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552953600000",
"number": "1376002287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1342 W LA GLORIA DR",
"city": "RIALTO",
"state": "CA",
"postal_code": "923774466",
"telephone_number": "951-465-9162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1342 W LA GLORIA DR",
"city": "RIALTO",
"state": "CA",
"postal_code": "923774466",
"telephone_number": "951-465-9162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICEA",
"first_name": "ERICA",
"middle_name": "BERENICE",
"name_prefix": "Ms.",
"credential": "RDA ORTHO ASSISTANT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-19",
"last_updated": "2019-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "66604",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "66604",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rialto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.