Active NPI
Kathleen Marie Dubose, CMT, CIIM,CA
- Specialist
- Modesto, CA
National Provider Identifier
1770622375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 1901 Standiford Ave
Suite a
Modesto, CA 95350-0149 - Phone
- (209) 324-2060
- NPI assigned
- Feb 6, 2007
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
1901 Standiford Ave
Suite a
Modesto, CA 95350-0149
Mailing address
4000 Shady Glen CT
Modesto, CA 95356-8795
Phone (209) 544-0549
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CE 0090497 | Other | CA | INSTRUCTOR TRAINING |
| 397085-00 | Other | CA | NCBTMB |
| CMT | Other | CA | TOUCHING FOR HEALTH |
| 795230 | Other | CA | ABMP |
| CE40HOURS | Other | CA | AROMTHERAPY ESSENTIALS |
| 492759 YLEO | Other | CA | INDEPENDENT DISTRIBUTOR |
| CE 12HOURS | Other | CA | CHAIR MASSAGE |
| CIIM | Other | CA | INSTRUCTOR CERTIFICATION |
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": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770622375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 SHADY GLEN CT",
"city": "MODESTO",
"state": "CA",
"postal_code": "953568795",
"telephone_number": "209-544-0549",
"fax_number": "209-577-3103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 STANDIFORD AVE",
"address_2": "SUITE A",
"city": "MODESTO",
"state": "CA",
"postal_code": "953500149",
"telephone_number": "209-324-2060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUBOSE",
"first_name": "KATHLEEN",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "CMT, CIIM,CA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INSTRUCTOR TRAINING",
"identifier": "CE 0090497",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCBTMB",
"identifier": "397085-00",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TOUCHING FOR HEALTH",
"identifier": "CMT",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ABMP",
"identifier": "795230",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AROMTHERAPY ESSENTIALS",
"identifier": "CE40HOURS",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENT DISTRIBUTOR",
"identifier": "492759 YLEO",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAIR MASSAGE",
"identifier": "CE 12HOURS",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INSTRUCTOR CERTIFICATION",
"identifier": "CIIM",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.