Active NPI
Fermin George Bautista, CMT
- Massage Therapist
- Concord, CA
National Provider Identifier
1205600558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 89262
- Practice address
- 1333 Willow Pass Rd Ste 110
Concord, CA 94520-5225 - Phone
- (925) 676-7431
- NPI assigned
- Nov 7, 2023
- Sex
- Male
- 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 | 89262 | CA | Primary |
Addresses
Primary practice location
1333 Willow Pass Rd Ste 110
Concord, CA 94520-5225
Mailing address
6 Sirah Dr
American Canyon, CA 94503-1460
Phone (707) 330-8431
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 |
|---|---|---|---|
| 89262 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699315200000",
"number": "1205600558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 SIRAH DR",
"city": "AMERICAN CANYON",
"state": "CA",
"postal_code": "945031460",
"telephone_number": "707-330-8431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1333 WILLOW PASS RD STE 110",
"city": "CONCORD",
"state": "CA",
"postal_code": "945205225",
"telephone_number": "925-676-7431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUTISTA",
"first_name": "FERMIN",
"middle_name": "GEORGE",
"name_prefix": "Mr.",
"credential": "CMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-11-07",
"last_updated": "2023-11-07",
"certification_date": "2023-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "89262",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.