Wendy J Carvajal, DDS
Individual provider Active NPI Dentist · San Andreas, CA
NPI 1740587229 · NPPES record last updated Dec 14, 2021
Key facts
- NPI
- 1740587229
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 60168 (CA)
- Practice address
- 1113 Highway 49
San Andreas, CA 95249 - Phone
- (209) 755-1460
- NPI assigned
- Feb 18, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211216000432 | CA | Practitioner - Dentist | 6800287475 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chapa-de Indian Health Program, Inc. | Current |
Accepting new patients | |
| Cares Community Health | Current |
Accepting new patients | |
| Cares Community Health | Current |
Accepting new patients | |
| Cares Community Health | Current | Accepting new patients |
Locations
11670 Atwood Rd
Auburn, CA 95603
Phone (530) 887-2800
1350 E Main St
Grass Valley, CA 95945
Phone (530) 477-8545
1500 21st St
Sacramento, CA 95811
Phone (916) 443-3299
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/AHHIAD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 60168 | CA | Yes |
Addresses
Primary practice location
1113 Highway 49
San Andreas, CA 95249
Mailing address
PO Box 939
Angels Camp, CA 95222-0939
Phone (209) 754-6262
Other practice location 1
2805 Carradale Dr
Roseville, CA 95661-4047
Phone (916) 677-6386
Other practice location 2
205 South St
Fort Bragg, CA 95437-5540
Phone (707) 964-1251
Other providers in San Andreas, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.