Individual provider Active NPI

Doris Arely Guevara, D.D.S.

  • General Practice Dentistry
  • Inglewood, CA
National Provider Identifier
1972696383
Registry record updated Dec 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
42656 Issued in CA
Practice address
652 E Regent St
Inglewood, CA 90301-1415
Phone
(310) 330-0604
Fax
(310) 330-0590
NPI assigned
Sep 30, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 42656 CA Primary

Addresses

Primary practice location

652 E Regent St
Inglewood, CA 90301-1415

Mailing address

652 E Regent St
Inglewood, CA 90301-1415
Phone (310) 330-0604

Other identifiers 1

IdentifierTypeStateIssuer
G9135001MedicaidCA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160127000625 CA Order and Referring Only - DentistPractitioner - Dentist 8022311992

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
42656CAMDLicensed Psychiatric Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Doris a. Guevara D.D.S., Inc General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386547200000",
    "number": "1972696383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "652 E REGENT ST",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903011415",
            "telephone_number": "310-330-0604",
            "fax_number": "310-330-0590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "652 E REGENT ST",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903011415",
            "telephone_number": "310-330-0604",
            "fax_number": "310-330-0590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUEVARA",
        "first_name": "DORIS",
        "middle_name": "ARELY",
        "name_prefix": "Ms.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-30",
        "last_updated": "2013-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G9135001",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Inglewood, CA

Sources for this page

Verify at the official NPI Registry.