Active NPI
Roberto S Vasquez, D.D.S
- Dentist
- Corona, CA
National Provider Identifier
1902935687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 46442
- Practice address
- 760 Washburn Ave
Suite 4
Corona, CA 92882-3303 - Phone
- (951) 737-4479
- Fax
- (951) 737-1602
- NPI assigned
- Mar 5, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 46442 | CA | Primary |
Addresses
Primary practice location
760 Washburn Ave
Suite 4
Corona, CA 92882-3303
Mailing address
2291 Mangular Ave
Corona, CA 92882-5788
Phone (951) 272-5906
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G92808-01 | Other | CA | MEDICAL DENTAL |
| 46442 | Other | AR | DENTAL LIC STATE OF CALIF |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902935687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2291 MANGULAR AVE",
"city": "CORONA",
"state": "CA",
"postal_code": "928825788",
"telephone_number": "951-272-5906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 WASHBURN AVE",
"address_2": "SUITE 4",
"city": "CORONA",
"state": "CA",
"postal_code": "928823303",
"telephone_number": "951-737-4479",
"fax_number": "951-737-1602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VASQUEZ",
"first_name": "ROBERTO",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "46442",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL DENTAL",
"identifier": "G92808-01",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LIC STATE OF CALIF",
"identifier": "46442",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.