Active NPI
Randall L Lonsbrough, DDS
- Prosthodontics
- San Luis Obispo, CA
National Provider Identifier
1750397410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 40663
- Practice address
- 628 California Blvd
Ste F1
San Luis Obispo, CA 93401-2574 - Phone
- (805) 544-3204
- Fax
- (805) 544-3240
- NPI assigned
- Aug 1, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 40663 | CA | Primary |
Addresses
Primary practice location
628 California Blvd
Ste F1
San Luis Obispo, CA 93401-2574
Mailing address
628 California Blvd
Ste F1
San Luis Obispo, CA 93401-2574
Phone (805) 544-3204
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- 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 |
|---|---|---|---|---|
| I20100726000455 | CA | Practitioner - Oral Surgery | 5991837072 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40663 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1417996800000",
"number": "1750397410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "628 CALIFORNIA BLVD",
"address_2": "STE F1",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934012574",
"telephone_number": "805-544-3204",
"fax_number": "805-544-3240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "628 CALIFORNIA BLVD",
"address_2": "STE F1",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934012574",
"telephone_number": "805-544-3204",
"fax_number": "805-544-3240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONSBROUGH",
"first_name": "RANDALL",
"middle_name": "L",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2014-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "CA",
"license": "40663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.