Gilbert N/a Pena, RDA

Primary specialty

Dental AssistantTaxonomy code 126800000X

License

RDA93312 Issued in CA

Practice address

1205 Renaissance Pkwy Ste 240
Rialto, CA 92376-2418

Phone

(909) 253-0490

NPI assigned

Dec 18, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• N/a N/a N/a Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1576627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1467090514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 RENAISSANCE PKWY STE 240",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923762418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 RENAISSANCE PKWY STE 240",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923762418",
            "telephone_number": "909-253-0490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "GILBERT",
        "middle_name": "N/A",
        "credential": "RDA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-18",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "CA",
            "license": "RDA93312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RDA93312",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "N/A",
            "last_name": "N/A",
            "middle_name": "N/A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Harold Glenn Patton, DIRECTOR
• Itzel Payan-Caro, MS, PPS
• Regina Joanna Peacock, LCSW
• Andrew Peckich
• Pedro M Sandoval DDS Corporation (Blue Crystal Dental)
• Emily Ann Penland
• Jasmine D Penn
• Velma L. Perdue, PA
• Sonia Perez Aguilar
• Adriana Perez

• Dental Assistant in Rialto, CA
• Providers in Rialto, CA by specialty
• Dental Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; 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.