Active NPI
Jennelyn Bacosa
- Registered Respiratory Therapist
- Richmond, CA
National Provider Identifier
1235928748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Respiratory Therapist
- License
- 24664
- Practice address
- 901 Nevin Ave
Richmond, CA 94801-3143 - Phone
- (510) 307-1500
- NPI assigned
- May 1, 2025
- Sex
- Unspecified or another gender identity
- 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 |
|---|---|---|---|---|
| Registered Respiratory Therapist | 227900000X | 24664 | CA | Primary |
Addresses
Primary practice location
901 Nevin Ave
Richmond, CA 94801-3143
Mailing address
31537 Hugh Way
Hayward, CA 94544-7743
Phone (562) 787-1864
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 |
|---|---|---|---|
| 24664 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1746057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746057600000",
"number": "1235928748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31537 HUGH WAY",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945447743",
"telephone_number": "562-787-1864",
"fax_number": "562-787-1864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 NEVIN AVE",
"city": "RICHMOND",
"state": "CA",
"postal_code": "948013143",
"telephone_number": "510-307-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACOSA",
"first_name": "JENNELYN",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2025-05-01",
"last_updated": "2025-05-01",
"certification_date": "2025-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "227900000X",
"taxonomy_group": "",
"desc": "Respiratory Therapist, Registered",
"state": "CA",
"license": "24664",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.