Active NPI
Timothy L Parks
- Massage Therapist
- Nuevo, CA
National Provider Identifier
1245071224
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 87395
- Practice address
- 22806 Mirileste Dr
Nuevo, CA 92567-9680 - Phone
- (951) 807-1143
- NPI assigned
- Jun 4, 2024
- Last updated
- Jun 4, 2024
- 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 87395 | CA | Primary |
Addresses
Primary practice location
22806 Mirileste Dr
Nuevo, CA 92567-9680
Mailing address
22806 Mirileste Dr
Nuevo, CA 92567-9680
Phone (951) 807-1143
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 |
|---|---|---|---|
| 87395 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717459200000",
"number": "1245071224",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22806 MIRILESTE DR",
"city": "NUEVO",
"state": "CA",
"postal_code": "925679680",
"telephone_number": "951-807-1143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22806 MIRILESTE DR",
"city": "NUEVO",
"state": "CA",
"postal_code": "925679680",
"telephone_number": "951-807-1143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARKS",
"first_name": "TIMOTHY",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-06-04",
"last_updated": "2024-06-04",
"certification_date": "2024-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "87395",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.