Active NPI
Luis C. Iravedra, DMD
- General Practice Dentistry
- Toa Alta, PR
National Provider Identifier
1760595334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1632
- Practice address
- Calle 1 A2
Urb.San Fernando
Toa Alta, PR 00953-0000 - Phone
- (787) 870-2019
- NPI assigned
- Aug 16, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1632 | PR | Primary |
Addresses
Primary practice location
Calle 1 A2
Urb.San Fernando
Toa Alta, PR 00953-0000
Mailing address
P.O.Box 1326
Toa Alta, PR 00954-0000
Phone (787) 870-2019
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
- 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 |
|---|---|---|---|---|
| I20151202002435 | PR | Order and Referring Only - Oral Surgery | 3173823887 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1632 | PR | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760595334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O.BOX 1326",
"city": "TOA ALTA",
"state": "PR",
"postal_code": "009540000",
"telephone_number": "787-870-2019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CALLE 1 A2",
"address_2": "URB.SAN FERNANDO",
"city": "TOA ALTA",
"state": "PR",
"postal_code": "009530000",
"telephone_number": "787-870-2019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IRAVEDRA",
"first_name": "LUIS",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PR",
"license": "1632",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Toa Alta, PR
- Innovative Medical and Radiology Management
- Integrative Psychological Services for the Family
- Invoga Chiropractic, LLC
- Ipa Municipal Toa Alta 357
- Ipm Health Services LLC
- Jasaes Medical Diagnostic Inc.
- Jimenez Chinea Renal Care LLC
- Anelys Janette Jimenez Rivas, MD
- Aida J Jimenez, RN
- Jose Angel Jimenez, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.