Active NPI
Philip Byron Maldonado, D.D.S.
- General Practice Dentistry
- Covina, CA
National Provider Identifier
1376635136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 33628
- Practice address
- 151 W College St
Covina, CA 91723-2008 - Phone
- (626) 332-2550
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 33628 | CA | Primary |
Addresses
Primary practice location
151 W College St
Covina, CA 91723-2008
Mailing address
151 W College St
Covina, CA 91723-2008
Phone (626) 332-2550
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160526001281 | CA | Order and Referring Only - Dentist | 5991095341 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Ownership & related parties
All facility ownership & control disclosures 4
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Emanate Health Inter-Community Hospital | Hospital | Corporate Officer | Jun 1, 2023 |
| Emanate Health Foothill Presbyterian Hospital | Hospital | Corporate Director | Jun 1, 2023 |
| Emanate Health Queen of the Valley Hospital | Hospital | Corporate Director | Jun 1, 2023 |
| Emanate Health Inter-Community Hospital | Skilled nursing facility | Corporate Director | Jun 1, 2023 |
Owned or controlled facilities with NPI records 6
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- General Acute Care Hospital
- Glendora, CA
- NPI 1992733513
Corporate Director
-
- General Acute Care Hospital
- West Covina, CA
- NPI 1063441293
Corporate Officer
-
- Rehabilitation Hospital Unit
- West Covina, CA
- NPI 1548294606
Corporate Director
-
- General Acute Care Hospital
- Covina, CA
- NPI 1982629440
Corporate Officer
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376635136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 W COLLEGE ST",
"city": "COVINA",
"state": "CA",
"postal_code": "917232008",
"telephone_number": "626-332-2550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 W COLLEGE ST",
"city": "COVINA",
"state": "CA",
"postal_code": "917232008",
"telephone_number": "626-332-2550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALDONADO",
"first_name": "PHILIP",
"middle_name": "BYRON",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "33628",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.