Active NPI
Josue Emanuel Menjivar, RDH
- Dental Hygienist
- Nipomo, CA
National Provider Identifier
1790432722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- RDH34547
- Practice address
- 150 Tejas PL
Nipomo, CA 93444-9123 - Phone
- (805) 929-3254
- Fax
- (805) 929-6359
- NPI assigned
- Mar 9, 2022
- 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 Hygienist | 124Q00000X | RDH34547 | CA | Primary |
Addresses
Primary practice location
150 Tejas PL
Nipomo, CA 93444-9123
Mailing address
150 Tejas PL
Nipomo, CA 93444-9123
Phone (805) 929-3254
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 |
|---|---|---|---|
| RDH34547 | CA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646784000000",
"number": "1790432722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 TEJAS PL",
"city": "NIPOMO",
"state": "CA",
"postal_code": "934449123",
"telephone_number": "805-929-3254",
"fax_number": "805-929-6359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 TEJAS PL",
"city": "NIPOMO",
"state": "CA",
"postal_code": "934449123",
"telephone_number": "805-929-3254",
"fax_number": "805-929-6359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENJIVAR",
"first_name": "JOSUE",
"middle_name": "EMANUEL",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-09",
"last_updated": "2022-03-09",
"certification_date": "2022-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CA",
"license": "RDH34547",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nipomo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.