Active NPI
Pablo Madrigal Walle, DDS
- Dentist
- Ceres, CA
National Provider Identifier
1457029167
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 106838
- Practice address
- 3100 E Service Rd
Ceres, CA 95307-6422 - Phone
- (209) 542-9921
- NPI assigned
- Aug 30, 2021
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 106838 | CA | Primary |
Addresses
Primary practice location
3100 E Service Rd
Ceres, CA 95307-6422
Mailing address
1547 Concerto LN # LM
Hughson, CA 95326-9136
Phone (209) 484-3078
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 106838 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667174400000",
"number": "1457029167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1547 CONCERTO LN # LM",
"city": "HUGHSON",
"state": "CA",
"postal_code": "953269136",
"telephone_number": "209-484-3078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 E SERVICE RD",
"city": "CERES",
"state": "CA",
"postal_code": "953076422",
"telephone_number": "209-542-9921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADRIGAL WALLE",
"first_name": "PABLO",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-08-30",
"last_updated": "2022-10-31",
"certification_date": "2022-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "106838",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ceres, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.