Stacey Lynne Boscoe

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

License

OW0009884 Issued in CA

Practice address

3540 Soquel Ave Ste D
Santa Cruz, CA 95062-1769

Phone

(831) 600-8911

Fax

(800) 808-2728

NPI assigned

Apr 19, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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.

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1417690272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 SOQUEL AVE STE D",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950621769",
            "telephone_number": "831-600-8911",
            "fax_number": "800-808-2728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 SOQUEL AVE STE D",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950621769",
            "telephone_number": "831-600-8911",
            "fax_number": "800-808-2728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSCOE",
        "first_name": "STACEY",
        "middle_name": "LYNNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-19",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Rehabilitation Practitioner",
            "state": "CA",
            "license": "OW0009884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rehabilitation Practitioner in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Rehabilitation Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; 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.