Individual provider Active NPI

Eleanor Antoinette Siazon, DDS

  • General Practice Dentistry
  • South Gate, CA
National Provider Identifier
1497891261
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
44086 Issued in CA
Practice address
4444 Tweedy Blvd
South Gate, CA 90280-6304
Phone
(323) 564-2444
Fax
(323) 249-7565
NPI assigned
Jan 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 44086 CA Primary

Addresses

Primary practice location

4444 Tweedy Blvd
South Gate, CA 90280-6304

Mailing address

421 W Alberta St
Anaheim, CA 92805-2611

Other identifiers 1

IdentifierTypeStateIssuer
D44086MedicaidCA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160118000535 CA Order and Referring Only - DentistPractitioner - Dentist 7517260078

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
44086CAMDProfessional Counselor

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1497891261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 W ALBERTA ST",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928052611",
            "fax_number": "323-249-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 TWEEDY BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806304",
            "telephone_number": "323-564-2444",
            "fax_number": "323-249-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIAZON",
        "first_name": "ELEANOR",
        "middle_name": "ANTOINETTE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D44086",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Gate, CA

Sources for this page

Verify at the official NPI Registry.