Active NPI
Ebonique Zanale Wilson
- Massage Therapist
- San Jose, CA
National Provider Identifier
1770181521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 12550
- Practice address
- 380 Vista Roma Way Unit 316
San Jose, CA 95136-4421 - Phone
- (408) 603-7012
- NPI assigned
- Oct 14, 2020
- Last updated
- Oct 14, 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 | 12550 | CA | Primary |
Addresses
Primary practice location
380 Vista Roma Way Unit 316
San Jose, CA 95136-4421
Mailing address
380 Vista Roma Way Unit 316
San Jose, CA 95136-4421
Phone (408) 603-7012
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602633600000",
"number": "1770181521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "380 VISTA ROMA WAY UNIT 316",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951364421",
"telephone_number": "408-603-7012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "380 VISTA ROMA WAY UNIT 316",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951364421",
"telephone_number": "408-603-7012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "EBONIQUE",
"middle_name": "ZANALE",
"name_prefix": "Miss",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-14",
"last_updated": "2020-10-14",
"certification_date": "2020-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "12550",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.