Active NPI
Santiago Alfonso Surillo, DDS MS
- Pediatric Dentistry
- La Mesa, CA
National Provider Identifier
1669521050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 41045
- Practice address
- 4700 Spring Street
Suite 104
La Mesa, CA 91941 - Phone
- (619) 461-6166
- Fax
- (619) 461-2508
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 41045 | CA | Primary |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 41045 | CA |
Addresses
Primary practice location
4700 Spring Street
Suite 104
La Mesa, CA 91941
Mailing address
4700 Spring Street
Suite 104
La Mesa, CA 91941
Phone (619) 461-6166
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41045 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413849600000",
"number": "1669521050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 SPRING STREET",
"address_2": "SUITE 104",
"city": "LA MESA",
"state": "CA",
"postal_code": "91941",
"telephone_number": "619-461-6166",
"fax_number": "619-461-2508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 SPRING STREET",
"address_2": "SUITE 104",
"city": "LA MESA",
"state": "CA",
"postal_code": "91941",
"telephone_number": "619-461-6166",
"fax_number": "619-461-2508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURILLO",
"first_name": "SANTIAGO",
"middle_name": "ALFONSO",
"credential": "DDS MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2014-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "41045",
"primary": true
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "41045",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.