Active NPI
Moise Etienne, BS
- Occupational Therapist
- San Diego, CA
National Provider Identifier
1013230630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 9962
- Practice address
- 1450 Frazee Rd
Suite 306
San Diego, CA 92108-4337 - Phone
- (877) 775-3003
- NPI assigned
- Mar 10, 2010
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 9962 | CA | Primary |
Addresses
Primary practice location
1450 Frazee Rd
Suite 306
San Diego, CA 92108-4337
Mailing address
4017 Township Square Blvd Apt 2621
Orlando, FL 32837-4309
Phone (877) 775-3000
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
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9962 | CA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sierra Therapy Services, Inc. | 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.
-
- Physical Therapist
- Stone Mountain, GA
- NPI 1083643449
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268179200000",
"number": "1013230630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4017 TOWNSHIP SQUARE BLVD APT 2621",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328374309",
"telephone_number": "877-775-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 FRAZEE RD",
"address_2": "SUITE 306",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921084337",
"telephone_number": "877-775-3003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETIENNE",
"first_name": "MOISE",
"name_prefix": "Mr.",
"credential": "BS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-03-10",
"last_updated": "2010-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "9962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.