Active NPI
Mauro Miramontes III
- Dental Assistant
- Riverside, CA
National Provider Identifier
1457897068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 79237
- Practice address
- 3380 La Sierra Ave
Riverside, CA 92503-5271 - Phone
- (951) 354-9999
- NPI assigned
- Jan 6, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 79237 | CA | Primary |
Addresses
Primary practice location
3380 La Sierra Ave
Riverside, CA 92503-5271
Mailing address
66031 1St St
Desert Hot Springs, CA 92240-3636
Phone (760) 620-4524
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 79237 | Medicaid | CA |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 79237 | CA | MD | Dental Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483660800000",
"number": "1457897068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "66031 1ST ST",
"city": "DESERT HOT SPRINGS",
"state": "CA",
"postal_code": "922403636",
"telephone_number": "760-620-4524"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3380 LA SIERRA AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925035271",
"telephone_number": "951-354-9999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRAMONTES",
"first_name": "MAURO",
"name_suffix": "III",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-01-06",
"last_updated": "2017-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "79237",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "79237",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.