Active NPI
Samuel Lardizabal, M.D.
- Anesthesiology Physician
- Upland, CA
National Provider Identifier
1992733596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- C37678
- Practice address
- 999 San Bernardino Rd
Upland, CA 91786-4920 - Phone
- (909) 985-2811
- NPI assigned
- Jun 30, 2006
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | C37678 | CA | Primary |
Addresses
Primary practice location
999 San Bernardino Rd
Upland, CA 91786-4920
Mailing address
PO Box 1628
Orange, CA 92856-0628
Phone (714) 560-1580
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C376780 | Medicaid | CA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C37678 | CA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424304000000",
"number": "1992733596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1628",
"city": "ORANGE",
"state": "CA",
"postal_code": "928560628",
"telephone_number": "714-560-1580",
"fax_number": "714-560-1585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "999 SAN BERNARDINO RD",
"city": "UPLAND",
"state": "CA",
"postal_code": "917864920",
"telephone_number": "909-985-2811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARDIZABAL",
"first_name": "SAMUEL",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-30",
"last_updated": "2015-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CA",
"license": "C37678",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00C376780",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.