Active NPI
Alberto Poncedeleon, DMD
- Dentist
- Sacramento, CA
National Provider Identifier
1578837050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 40875
- Practice address
- 1589 W El Camino Ave
Sacramento, CA 95833-1997 - Phone
- (916) 564-2020
- Fax
- (916) 564-3900
- NPI assigned
- Mar 1, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 40001 | CA | |
| Dentist | 122300000X | 40875 | CA | Primary |
Addresses
Primary practice location
1589 W El Camino Ave
Sacramento, CA 95833-1997
Mailing address
1589 West El Camino Avenue
Sacramento, CA 95833
Phone (916) 564-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851693295 | Other | CA | DENTAL |
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 |
|---|---|---|---|
| 40875 | CA | MD | Marriage & Family Therapist |
| 40001 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330560000000",
"number": "1578837050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1589 WEST EL CAMINO AVENUE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "95833",
"telephone_number": "916-564-2020",
"fax_number": "916-564-3900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1589 W EL CAMINO AVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958331997",
"telephone_number": "916-564-2020",
"fax_number": "916-564-3900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONCEDELEON",
"first_name": "ALBERTO",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-03-01",
"last_updated": "2012-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "40001",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "40875",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL",
"identifier": "1851693295",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.