Active NPI
Malik Roshon Coleman
- Massage Therapist
- Upland, CA
National Provider Identifier
1609761428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 78959
- Practice address
- 440 Alpine Street
Upland, CA 91786 - Phone
- (619) 887-3816
- NPI assigned
- Jun 11, 2025
- 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 | 78959 | CA | Primary |
Addresses
Primary practice location
440 Alpine Street
Upland, CA 91786
Mailing address
440 Alpine Street
Upland, CA 91786
Phone (619) 887-3816
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 |
|---|---|---|---|
| 78959 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749600000000",
"number": "1609761428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "440 ALPINE STREET",
"city": "UPLAND",
"state": "CA",
"postal_code": "91786",
"telephone_number": "619-887-3816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 ALPINE STREET",
"city": "UPLAND",
"state": "CA",
"postal_code": "91786",
"telephone_number": "619-887-3816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLEMAN",
"first_name": "MALIK",
"middle_name": "ROSHON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-06-11",
"last_updated": "2025-06-11",
"certification_date": "2025-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "CA",
"license": "78959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.