Active NPI
Krystle Padre Rapisura, DMD
- Pediatric Dentistry
- Pomona, CA
National Provider Identifier
1932521952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 64407
- Practice address
- 309 E 2ND St
Pomona, CA 91766-1854 - Phone
- (626) 453-3710
- NPI assigned
- Jan 9, 2014
- Last updated
- Oct 28, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 64407 | CA | Primary |
Addresses
Primary practice location
309 E 2ND St
Pomona, CA 91766-1854
Mailing address
205 S Vendome St
Los Angeles, CA 90057-1117
Phone (951) 833-7248
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151103001310 | CA | Order and Referring Only - Other (Physician) | 2062722044 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64407 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445990400000",
"number": "1932521952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 S VENDOME ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900571117",
"telephone_number": "951-833-7248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 E 2ND ST",
"city": "POMONA",
"state": "CA",
"postal_code": "917661854",
"telephone_number": "626-453-3710"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAPISURA",
"first_name": "KRYSTLE",
"middle_name": "PADRE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-01-09",
"last_updated": "2015-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "64407",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; 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.