Individual provider Active NPI

Karina Ballesteros, RDHAP

  • Advanced Practice Dental Therapist
  • Livermore, CA
National Provider Identifier
1376243758
Registry record updated Mar 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice Dental TherapistTaxonomy code 125K00000X
License
944 Issued in CA
Practice address
1498 N Vasco Rd
Livermore, CA 94551-9213
Phone
(925) 454-1132
NPI assigned
Mar 6, 2023
Last updated
Mar 19, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Dental Therapist 125K00000X 944 CA Primary

Addresses

Primary practice location

1498 N Vasco Rd
Livermore, CA 94551-9213

Mailing address

101 E Vineyard Ave
Ste 119 #112
Livermore, CA 94550

Other identifiers 1

IdentifierTypeStateIssuer
944OtherCADENTAL HYGIENE BOARD OF CALIFORNIA

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
944CAMDAdvanced Practice Dental Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
William G Tin DDS Inc PastSince Mar 12, 2023 Accepting new patients

Organizations & group practices 1

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": "1678060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679184000000",
    "number": "1376243758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E VINEYARD AVE",
            "address_2": "STE 119 #112",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "94550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1498 N VASCO RD",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945519213",
            "telephone_number": "925-454-1132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLESTEROS",
        "first_name": "KARINA",
        "credential": "RDHAP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-06",
        "last_updated": "2023-03-19",
        "certification_date": "2023-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "125K00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Dental Therapist",
            "state": "CA",
            "license": "944",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL HYGIENE BOARD OF CALIFORNIA",
            "identifier": "944",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Livermore, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2023; 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.