Active NPI
Andrea Reyes
- Massage Therapist
- Santa Rosa, CA
National Provider Identifier
1679181580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 84505
- Practice address
- 2462 W 3Rd St
Santa Rosa, CA 95401-6425 - Phone
- (707) 843-3539
- NPI assigned
- Jul 16, 2020
- 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 | 84505 | CA | Primary |
Addresses
Primary practice location
2462 W 3Rd St
Santa Rosa, CA 95401-6425
Mailing address
2462 W 3Rd St
Santa Rosa, CA 95401-6425
Phone (707) 843-3539
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 |
|---|---|---|---|
| 84505 | CA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Soulstice Spa LLC | Multi-Specialty | Current | Accepting new patients |
Locations
2462 W 3rd St
Santa Rosa, CA 95401
Phone (707) 843-3539
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594857600000",
"number": "1679181580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2462 W 3RD ST",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954016425",
"telephone_number": "707-843-3539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2462 W 3RD ST",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954016425",
"telephone_number": "707-843-3539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYES",
"first_name": "ANDREA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-16",
"last_updated": "2020-07-16",
"certification_date": "2020-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "CA",
"license": "84505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.