Active NPI
Alfred A Medina, DDS
- Dentist
- Chula Vista, CA
National Provider Identifier
1932576824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 29371
- Practice address
- 309 3Rd Ave
Chula Vista, CA 91910-3910 - Phone
- (619) 420-6030
- Fax
- (619) 420-9102
- NPI assigned
- Aug 26, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 29371 | CA | Primary |
Addresses
Primary practice location
309 3Rd Ave
Chula Vista, CA 91910-3910
Mailing address
309 3Rd Ave
Chula Vista, CA 91910-3910
Phone (619) 420-6030
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000475909 | Other | CA | UNITED COCORDIA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29371 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440547200000",
"number": "1932576824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 3RD AVE",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919103910",
"telephone_number": "619-420-6030",
"fax_number": "619-420-9102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 3RD AVE",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919103910",
"telephone_number": "619-420-6030",
"fax_number": "619-420-9102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "ALFRED",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-26",
"last_updated": "2015-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "29371",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED COCORDIA",
"identifier": "000475909",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.