Active NPI
Angel Estuardo Ceballos
- Dentist
- Rohnert Park, CA
National Provider Identifier
1508622721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 112022
- Practice address
- 5900 State Farm Dr FL 2
Rohnert Park, CA 94928-2149 - Phone
- (707) 559-7500
- NPI assigned
- Feb 26, 2024
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 112022 | CA | Primary |
Addresses
Primary practice location
5900 State Farm Dr FL 2
Rohnert Park, CA 94928-2149
Mailing address
101 Woodland Ave
San Francisco, CA 94117-3862
Other practice location 1
707 Parnassus Ave
San Francisco, CA 94143-2210
Phone (415) 502-5800
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 |
|---|---|---|---|
| 112022 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752710400000",
"number": "1508622721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 WOODLAND AVE",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941173862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5900 STATE FARM DR FL 2",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949282149",
"telephone_number": "707-559-7500"
}
],
"practiceLocations": [
{
"address_1": "707 Parnassus Ave",
"address_purpose": "LOCATION",
"city": "San Francisco",
"state": "CA",
"postal_code": "941432210",
"country_code": "US",
"telephone_number": "415-502-5800",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CEBALLOS",
"first_name": "ANGEL",
"middle_name": "ESTUARDO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-02-26",
"last_updated": "2025-07-17",
"certification_date": "2025-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "112022",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rohnert Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.