Active NPI
Marissa Faeldan-Suarez
- Dentist
- Los Angeles, CA
National Provider Identifier
1487941340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 58944
- Practice address
- 1827 Greenfield Ave Apt 105
Los Angeles, CA 90025-4409 - Phone
- (626) 379-1110
- NPI assigned
- Jun 29, 2011
- Sex
- Female
- 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 | 58944 | CA | Primary |
Addresses
Primary practice location
1827 Greenfield Ave Apt 105
Los Angeles, CA 90025-4409
Mailing address
16018 Amar Rd
City of Industry, CA 91744-2203
Phone (626) 968-7525
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 |
|---|---|---|---|---|
| I20160202002791 | CA | Order and Referring Only - Oral Surgery | 1557665114 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58944 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marissa Faeldan-Suarez, DDS, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- City of Industry, CA
- NPI 1124457668
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366329600000",
"number": "1487941340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16018 AMAR RD",
"city": "CITY OF INDUSTRY",
"state": "CA",
"postal_code": "917442203",
"telephone_number": "626-968-7525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1827 GREENFIELD AVE APT 105",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900254409",
"telephone_number": "626-379-1110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAELDAN-SUAREZ",
"first_name": "MARISSA",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-29",
"last_updated": "2013-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "58944",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2013; 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.