Active NPI
Pablo Daniel Fernandez
- General Practice Dentistry
- Modesto, CA
National Provider Identifier
1407985666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 52854
- Practice address
- 803 Coffee Rd Ste 8
Modesto, CA 95355-4245 - Phone
- (209) 920-4300
- Fax
- (209) 521-5455
- NPI assigned
- Mar 5, 2007
- 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 | 52854 | CA | Primary |
Addresses
Primary practice location
803 Coffee Rd Ste 8
Modesto, CA 95355-4245
Mailing address
803 Coffee Rd Ste 8
Modesto, CA 95355-4245
Phone (209) 277-2876
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 |
|---|---|---|---|---|
| I20210310002091 | CA | Practitioner - Dentist | 9032520796 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283385600000",
"number": "1407985666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "803 COFFEE RD STE 8",
"city": "MODESTO",
"state": "CA",
"postal_code": "953554245",
"telephone_number": "209-277-2876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "803 COFFEE RD STE 8",
"city": "MODESTO",
"state": "CA",
"postal_code": "953554245",
"telephone_number": "209-920-4300",
"fax_number": "209-521-5455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDEZ",
"first_name": "PABLO",
"middle_name": "DANIEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2010-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "52854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.