Individual provider Active NPI

Fernando Salvador Ayala Negrete

  • General Practice Dentistry
  • Van Nuys, CA
National Provider Identifier
1548146947
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
112155 Issued in CA
Practice address
13716 Sherman Way
Van Nuys, CA 91405-2626
Phone
(818) 962-1790
NPI assigned
Aug 12, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

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 112155 CA Primary

Addresses

Primary practice location

13716 Sherman Way
Van Nuys, CA 91405-2626

Mailing address

15207 Camarillo St
Sherman Oaks, CA 91403-1917
Phone (818) 298-0655

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

LicenseStateTypeSpecialty
112155CAMDPsychiatry Physician

NPI Registry JSON

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

{
    "created_epoch": "1754956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754956800000",
    "number": "1548146947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15207 CAMARILLO ST",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914031917",
            "telephone_number": "818-298-0655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13716 SHERMAN WAY",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914052626",
            "telephone_number": "818-962-1790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYALA NEGRETE",
        "first_name": "FERNANDO",
        "middle_name": "SALVADOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-12",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "112155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.

Verify at the official NPI Registry.