Active NPI
Tanya Haughawout, CMT
- Massage Therapist
- Costa Mesa, CA
National Provider Identifier
1023617875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 42775
- Practice address
- 1202 Bristol St Ste 200
Costa Mesa, CA 92626-8607 - Phone
- (714) 424-9001
- NPI assigned
- Oct 22, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 42775 | CA | Primary |
Addresses
Primary practice location
1202 Bristol St Ste 200
Costa Mesa, CA 92626-8607
Mailing address
16412 Rhone LN
Huntington Beach, CA 92647-4129
Phone (805) 304-2701
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | PECOS |
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 |
|---|---|---|---|
| 42775 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603324800000",
"number": "1023617875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16412 RHONE LN",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926474129",
"telephone_number": "805-304-2701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1202 BRISTOL ST STE 200",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926268607",
"telephone_number": "714-424-9001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAUGHAWOUT",
"first_name": "TANYA",
"credential": "CMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-22",
"last_updated": "2020-10-22",
"certification_date": "2020-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "42775",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "PECOS",
"affiliation": "N",
"endpointDescription": "Internet-based Provider Enrollment, Chain and Ownership System",
"address_1": "1202 Bristol St Ste 200",
"city": "Costa Mesa",
"state": "CA",
"country_code": "US",
"postal_code": "926268607",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.