NPIMap

Organization Active NPI

Sandra Calleros, a Professional Corp

  • General Practice Dentistry
  • El Segundo, CA
National Provider Identifier
1891188371
Registry record updated Mar 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
35478 Issued in CA
Legal business name
SANDRA CALLEROS, A PROFESSIONAL CORP
Practice address
131 W Grand Ave
Suite B
El Segundo, CA 90245-3738
Phone
(310) 414-9564
Fax
(310) 414-9773
NPI assigned
Mar 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2015

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

Authorized official

Name
Dr. Sandra Calleros, DDSNPI 1316940315
Title
Owner
Phone
(310) 414-9564

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 35478 CA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 62902 CA

Addresses

Primary practice location

131 W Grand Ave
Suite B
El Segundo, CA 90245-3738

Mailing address

131 W Grand Ave
Suite B
El Segundo, CA 90245-3738
Phone (310) 414-9564

Other names 1

  • Calleros Dental Other name

National Provider Directory

National Provider Directory

Locations

131 W Grand Ave
Ste B
El Segundo, CA 90245
Phone (310) 414-9564

Practitioners & affiliated clinicians

Practitioners 2

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": "1425859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1891188371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 W GRAND AVE",
            "address_2": "SUITE B",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453738",
            "telephone_number": "310-414-9564",
            "fax_number": "310-414-9773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 W GRAND AVE",
            "address_2": "SUITE B",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453738",
            "telephone_number": "310-414-9564",
            "fax_number": "310-414-9773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDRA CALLEROS, A PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-09",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "CALLEROS",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-414-9564",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "35478",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "62902",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Calleros Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in El Segundo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; 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.