Wagner De Luca Faria, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

44169 Issued in CA

Practice address

143 N Plymouth Way
San Bernardino, CA 92408-4173

Phone

(909) 533-4139

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484870400000",
    "number": "1912017302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 N PLYMOUTH WAY",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924084173",
            "telephone_number": "909-533-4139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 N PLYMOUTH WAY",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924084173",
            "telephone_number": "909-533-4139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARIA",
        "first_name": "WAGNER",
        "middle_name": "DE LUCA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2017-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Service Agency of San Bernardino
• Family Services of San Bernardino
• Family Wellness Medical Corporation
• Jennifer Adel Farag, M.S.
• Neal Robert Farber, RPH
• Fariborz Lalezarzadeh DO Inc
• Athena Christine Farmer
• Leah Farmer
• Taryn Faulk
• Jessica Faust

• General Practice Dentistry in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.