NPIMap

Organization Active NPI

P. Pablo Gonzalez, DDS, a Prof Corp

  • Dentist
  • Moreno Valley, CA
National Provider Identifier
1881084374
Registry record updated Jan 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
46808 Issued in CA
Legal business name
P. PABLO GONZALEZ, DDS, A PROF CORP
Practice address
15952 Perris Blvd Ste E
Moreno Valley, CA 92551-1320
Phone
(951) 243-0282
NPI assigned
Feb 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Pedro P Gonzalez, DDS
Title
Cheff Executive
Phone
(951) 243-0282

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 46808 CA Primary

Addresses

Primary practice location

15952 Perris Blvd Ste E
Moreno Valley, CA 92551-1320

Mailing address

15952 Perris Blvd Ste E
Moreno Valley, CA 92551-1320
Phone (951) 243-0282

National Provider Directory

National Provider Directory

Locations

15952 Perris Blvd
Ste E
Moreno Valley, CA 92551
Phone (951) 243-0282

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451952000000",
    "number": "1881084374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15952 PERRIS BLVD STE E",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925511320",
            "telephone_number": "951-243-0282",
            "fax_number": "951-243-1457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15952 PERRIS BLVD STE E",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925511320",
            "telephone_number": "951-243-0282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P. PABLO GONZALEZ, DDS, A PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-04",
        "last_updated": "2016-01-05",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "PEDRO",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHEFF EXECUTIVE",
        "authorized_official_telephone_number": "951-243-0282",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "46808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.