Eloise Catherine Thacker, C70773

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

C70773 Issued in CA

Practice address

355 E 21St St
San Bernardino, CA 92404-4824

Phone

(909) 882-0193

Fax

(909) 883-4834

NPI assigned

Sep 3, 2024

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

Practice roles

Locations

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.

• Beeman's Boutique LLC

  • Durable Medical Equipment & Medical Supplies
  • San Bernardino, CA
  • NPI 1730126608
  NPD
• Beemans Boutique LLC

  • Prosthetic/Orthotic Supplier
  • San Bernardino, CA
  • NPI 1518737006
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1730914458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 E 21ST ST STE J",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044851",
            "telephone_number": "909-882-0193",
            "fax_number": "909-883-4834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 E 21ST ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044824",
            "telephone_number": "909-882-0193",
            "fax_number": "909-883-4834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKER",
        "first_name": "ELOISE",
        "middle_name": "CATHERINE",
        "credential": "C70773",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-03",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "C70773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Terry-Hobson
• Barak Tessler, M.A.
• Angelo Lucero Teves
• Richard Pamplona Teves, RN
• Edward Charles Teyber
• Sabrina Shrita Thakur, MASTER OF SCIENCE
• Thanh K Pham DDS Inc.
• Priya Rose Tharayil, LCSW
• Christina Marie Tharpe
• The City Center SB

• Durable Medical Equipment & Medical Supplies in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; 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.