Bryan M Booth, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2000026488 Issued in CA

Practice address

74910 Aztec Rd
Palm Desert, CA 92260-3101

Phone

(916) 880-8858

NPI assigned

Oct 4, 2017

Sex

Male

Sole proprietor

No

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": "1507075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507075200000",
    "number": "1619487501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80123 QUEENSBORO DR",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922010523",
            "telephone_number": "916-880-8858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74910 AZTEC RD",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922603101",
            "telephone_number": "916-880-8858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "BRYAN",
        "middle_name": "M",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-04",
        "last_updated": "2017-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": "2000026488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Xiomaria Boga
• Kristen Lee Bohnet, D.C., L.AC.
• Patti J Boiko, SPEECH LANGUAGE PATH
• Oriana Bolds
• Maria E Bonnell
• Alexandria Liann Boppart
• Katlyn Border
• Theodore Patrick Borges, C.N.A.H.H.A.
• Michael D Borovac, DDS
• Olayinka Anjali Bossa

• Athletic Trainer in Palm Desert, CA
• Providers in Palm Desert, CA by specialty
• Athletic Trainer in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2017; 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.