Moon Leaf Derosier, CMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

10405 Issued in CA

Practice address

5960B West Mall
Atascadero, CA 93422-4232

Phone

(415) 706-6397

NPI assigned

Jul 20, 2016

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 20, 2016.

{
    "created_epoch": "1468972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468972800000",
    "number": "1043663438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4273",
            "city": "PASO ROBLES",
            "state": "CA",
            "postal_code": "934474273",
            "telephone_number": "415-706-6397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5960B WEST MALL",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934224232",
            "telephone_number": "415-706-6397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROSIER",
        "first_name": "MOON LEAF",
        "credential": "CMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-20",
        "last_updated": "2016-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": "10405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joevilyn Trance Delos Trino, NP
• Aline Galilee Deluca
• Heather Demosthenes, M.S., CCC-SLP
• Department of State Hospitals
• Melissa Depoorter, PHD, LMFT
• Elisabeth Deswart, MS RD
• Deirdre J Devlin, LCSW
• Mary Catherine Espiritu Diaz, FNP-C
• Miguel Karlo Lacson Diaz, FNP-C
• Richard H Diel, RPT

• All providers in Atascadero, CA
• Massage Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.