Active NPI
Stephanie Rachele Bacquet
- Massage Therapist
- Cedarpines Park, CA
National Provider Identifier
1558667824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 18978
- Practice address
- 22077 Mockingbird Lane
Cedarpines Park, CA 92322 - Phone
- (909) 338-7185
- NPI assigned
- Feb 4, 2011
- Last updated
- Mar 10, 2011
- Sex
- Female
- 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 | 18978 | CA | Primary |
Addresses
Primary practice location
22077 Mockingbird Lane
Cedarpines Park, CA 92322
Mailing address
PO Box 5176
Crestline, CA 92325-5176
Phone (909) 338-7185
Other names 1
- Stephanie Rachele Mathews
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 |
|---|---|---|---|
| 18978 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299715200000",
"number": "1558667824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5176",
"city": "CRESTLINE",
"state": "CA",
"postal_code": "923255176",
"telephone_number": "909-338-7185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22077 MOCKINGBIRD LANE",
"city": "CEDARPINES PARK",
"state": "CA",
"postal_code": "92322",
"telephone_number": "909-338-7185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACQUET",
"first_name": "STEPHANIE",
"middle_name": "RACHELE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-02-04",
"last_updated": "2011-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "18978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STEPHANIE",
"last_name": "MATHEWS",
"middle_name": "RACHELE",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Cedarpines Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.