NPIMap

Organization Active NPI

Erwin T Carracedo DMD, Inc

  • Dentist
  • South San Francisco, CA
National Provider Identifier
1619292117
Registry record updated Mar 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
40417 Issued in CA
Legal business name
ERWIN T CARRACEDO DMD, INC
Practice address
3540 Callan Blvd. Ste 100
South San Francisco, CA 94080
Phone
(650) 742-9092
Fax
(650) 742-9093
NPI assigned
Mar 29, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2010

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

Authorized official

Name
Dr. Erwin Tamayo Carracedo, DMDNPI 1164625075
Title
President
Phone
(650) 742-9092

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 40417 CA Primary

Addresses

Primary practice location

3540 Callan Blvd. Ste 100
South San Francisco, CA 94080

Mailing address

3540 Callan Blvd. Ste 100
South San Francisco, CA 94080
Phone (650) 742-9092

National Provider Directory

National Provider Directory

Locations

3540 Callan Blvd
Ste 100
South San Francisco, CA 94080
Phone (650) 742-9092

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1269820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269820800000",
    "number": "1619292117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 CALLAN BLVD. STE 100",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94080",
            "telephone_number": "650-742-9092",
            "fax_number": "650-742-9093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 CALLAN BLVD. STE 100",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94080",
            "telephone_number": "650-742-9092",
            "fax_number": "650-742-9093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERWIN T CARRACEDO DMD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-29",
        "last_updated": "2010-03-29",
        "status": "A",
        "authorized_official_last_name": "CARRACEDO",
        "authorized_official_first_name": "ERWIN",
        "authorized_official_middle_name": "TAMAYO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "650-742-9092",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "40417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; 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.