Active NPI
Sandy Lopez Avila, DDS
- Dentist
- Loma Linda, CA
National Provider Identifier
1720701287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 107979
- Practice address
- 11695 Welebir St
Loma Linda, CA 92354-3652 - Phone
- (602) 396-9657
- NPI assigned
- Sep 20, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 107979 | CA | Primary |
Addresses
Primary practice location
11695 Welebir St
Loma Linda, CA 92354-3652
Mailing address
11695 Welebir St
Loma Linda, CA 92354-3652
Phone (602) 396-9657
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260414000459 | MO | Order and Referring Only - Oral Surgery | 9032684402 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107979 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663632000000",
"number": "1720701287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11695 WELEBIR ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923543652",
"telephone_number": "602-396-9657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11695 WELEBIR ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923543652",
"telephone_number": "602-396-9657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ AVILA",
"first_name": "SANDY",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-20",
"last_updated": "2022-09-20",
"certification_date": "2022-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "107979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.