Active NPI
Favio Alberto Leon Jr., RDA
- Dental Assistant
- Los Angeles, CA
National Provider Identifier
1790050540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 77346
- Practice address
- 2604 S. Vermont Ave., #F
West Coast Dental Group
Los Angeles, CA 90007 - Phone
- (323) 731-3333
- NPI assigned
- Mar 13, 2012
- 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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 77346 | CA | Primary |
Addresses
Primary practice location
2604 S. Vermont Ave., #F
West Coast Dental Group
Los Angeles, CA 90007
Mailing address
133 N Reno St Apt 208
Los Angeles, CA 90026-4678
Phone (213) 858-8748
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 77346 | Other | CA | RDA LICENSE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77346 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331596800000",
"number": "1790050540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "133 N RENO ST APT 208",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900264678",
"telephone_number": "213-858-8748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2604 S. VERMONT AVE., #F",
"address_2": "WEST COAST DENTAL GROUP",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90007",
"telephone_number": "323-731-3333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEON",
"first_name": "FAVIO",
"middle_name": "ALBERTO",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "RDA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-03-13",
"last_updated": "2012-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "77346",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RDA LICENSE",
"identifier": "77346",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.