Individual provider Active NPI

Julio Cesar Escobedo, RDA

  • Dental Assistant
  • South Gate, CA
National Provider Identifier
1679710743
Registry record updated Jan 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental AssistantTaxonomy code 126800000X
License
70766 Issued in CA
Practice address
4149 Tweedy Blvd Ste J
South Gate, CA 90280-6167
Phone
(323) 567-3333
NPI assigned
Jan 12, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 12, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Assistant 126800000X 70766 CA Primary

Addresses

Primary practice location

4149 Tweedy Blvd Ste J
South Gate, CA 90280-6167

Mailing address

9841 Madison Ave Apt C
South Gate, CA 90280-4341
Phone (323) 572-5921

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

NPI Registry JSON

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

{
    "created_epoch": "1231718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231718400000",
    "number": "1679710743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9841 MADISON AVE APT C",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902804341",
            "telephone_number": "323-572-5921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4149 TWEEDY BLVD STE J",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806167",
            "telephone_number": "323-567-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESCOBEDO",
        "first_name": "JULIO",
        "middle_name": "CESAR",
        "credential": "RDA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-01-12",
        "last_updated": "2009-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "CA",
            "license": "70766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Gate, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2009; 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.