Individual provider Active NPI

Bianca Patricia Nino-Lanathoua

  • Dentist
  • Fontana, CA
National Provider Identifier
1396474813
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
109404 Issued in CA
Practice address
16944 S Highland Ave Ste 400
Fontana, CA 92336-3467
Phone
(909) 275-7179
NPI assigned
Jun 9, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 109404 CA Primary

Addresses

Primary practice location

16944 S Highland Ave Ste 400
Fontana, CA 92336-3467

Mailing address

841 S Terri Ann Dr
West Covina, CA 91791-3238
Phone (909) 614-5909

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240201000570 CA Order and Referring Only - DentistPractitioner - Dentist 5193178515

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
109404CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Schmidt and Jefferson Dental Corporation Dentist PastSince Sep 17, 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1654732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1396474813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 S TERRI ANN DR",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917913238",
            "telephone_number": "909-614-5909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16944 S HIGHLAND AVE STE 400",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923363467",
            "telephone_number": "909-275-7179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NINO-LANATHOUA",
        "first_name": "BIANCA",
        "middle_name": "PATRICIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-09",
        "last_updated": "2023-09-12",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "109404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.