Active NPI
Mauricio Ronderos, DDS, MS, MPH
- Periodontics
- Redwood City, CA
National Provider Identifier
1457402034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 47787
- Practice address
- 358 Marine Pkwy Ste 300
Redwood City, CA 94065-5211 - Phone
- (650) 595-5083
- Fax
- (650) 594-9236
- NPI assigned
- Jan 12, 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 47787 | CA | Primary |
Addresses
Primary practice location
358 Marine Pkwy Ste 300
Redwood City, CA 94065-5211
Mailing address
358 Marine Pkwy Ste 300
Redwood City, CA 94065-5211
Phone (650) 595-5083
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47787 | Other | CA | DENTAL LINSENCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 10, 2018 through May 10, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47787 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457402034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "358 MARINE PKWY STE 300",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940655211",
"telephone_number": "650-595-5083",
"fax_number": "650-594-9236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "358 MARINE PKWY STE 300",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940655211",
"telephone_number": "650-595-5083",
"fax_number": "650-594-9236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RONDEROS",
"first_name": "MAURICIO",
"name_prefix": "Dr.",
"credential": "DDS, MS, MPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "47787",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LINSENCE",
"identifier": "47787",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redwood City, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.