Active NPI
Omar Islas
- Dental Assistant
- Los Angeles, CA
National Provider Identifier
1396187019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 67395
- Practice address
- 440 N Coronado St Unit 207
Los a Ngeles, CA 90026 - Phone
- (818) 441-3866
- NPI assigned
- Jul 23, 2013
- 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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 67395 | CA | Primary |
Addresses
Primary practice location
440 N Coronado St Unit 207
Los a Ngeles, CA 90026
Mailing address
440 N Coronado St Apt 207
Los Angeles, CA 90026-4828
Phone (818) 441-3866
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 |
|---|---|---|---|
| 67395 | CA | MD | Dental Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374537600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374537600000",
"number": "1396187019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "440 N CORONADO ST APT 207",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900264828",
"telephone_number": "818-441-3866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 N CORONADO ST UNIT 207",
"city": "LOS A NGELES",
"state": "CA",
"postal_code": "90026",
"telephone_number": "818-441-3866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISLAS",
"first_name": "OMAR",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-23",
"last_updated": "2013-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "67395",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.