Individual provider Active NPI

Aurea Ballat Crisostomo-Reyes, D.M.D.

  • General Practice Dentistry
  • San Diego, CA
National Provider Identifier
1407903487
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
41382 Issued in CA
Practice address
9844 Hibert St
Suite G-7
San Diego, CA 92131-1000
Phone
(858) 271-7440
Fax
(858) 271-0180
NPI assigned
Jan 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 41382 CA Primary

Addresses

Primary practice location

9844 Hibert St
Suite G-7
San Diego, CA 92131-1000

Mailing address

11633 Winding Ridge Dr
San Diego, CA 92131-6158
Phone (858) 578-2912

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
41382CAMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407903487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11633 WINDING RIDGE DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921316158",
            "telephone_number": "858-578-2912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9844 HIBERT ST",
            "address_2": "SUITE G-7",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921311000",
            "telephone_number": "858-271-7440",
            "fax_number": "858-271-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISOSTOMO-REYES",
        "first_name": "AUREA",
        "middle_name": "BALLAT",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "41382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.