NPIMap

Individual provider Active NPI

Patricio Andres, PEDIATRIC DENTIST

  • Pediatric Dentistry
  • Chula Vista, CA
National Provider Identifier
1689985905
Registry record updated Jul 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
55782 Issued in CA
Practice address
397 E St
Ste #a
Chula Vista, CA 91910
Phone
(619) 425-9930
Fax
(619) 425-9887
NPI assigned
Jul 1, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 55782 CA Primary

Addresses

Primary practice location

397 E St
Ste #a
Chula Vista, CA 91910

Mailing address

397 E St
Ste #a
Chula Vista, CA 91910
Phone (619) 425-9930

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

Practice roles

OrganizationSpecialtyStatusNew patients
Safoura Massoumi Professional Dental Corp. Pediatric Dentistry Past Accepting new patients
The Safoura Massouri Professional Dental Corp Pediatric Dentistry Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1277942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277942400000",
    "number": "1689985905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "397 E ST",
            "address_2": "STE #A",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "91910",
            "telephone_number": "619-425-9930",
            "fax_number": "619-425-9887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "397 E ST",
            "address_2": "STE #A",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "91910",
            "telephone_number": "619-425-9930",
            "fax_number": "619-425-9887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRES",
        "first_name": "PATRICIO",
        "credential": "PEDIATRIC DENTIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-01",
        "last_updated": "2010-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "55782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.