Jutta Fonseca, MA61091263

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA61091263 Issued in WA

Practice address

8604 Pacific Ave SE
Olympia, WA 98513-2008

Phone

(253) 678-0598

NPI assigned

Aug 11, 2020

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

Electronic endpoints 1

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": "1597104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1801407002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5815 LACEY BLVD SE # 5885",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985032459",
            "telephone_number": "253-678-0598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8604 PACIFIC AVE SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985132008",
            "telephone_number": "253-678-0598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONSECA",
        "first_name": "JUTTA",
        "credential": "MA61091263",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-11",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61091263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Noterro",
            "affiliation": "N",
            "endpointDescription": "Formerly known as SOAP Vault",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8604 Pacific Ave SE",
            "city": "Olympia",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985132008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• FMG Capitol Mall Drive Southwest Washington LLC
• Julie J. Fogliano, MSW
• Arthur Lee Foley III, M.D.
• Vivian L Folsom, MSS
• Meghan Fonken, PA-C
• Princewill Fonta, PMHNP
• Larry L Fontanilla Jr., MD
• Ahmad Fora, MD
• Forest Shores Capital
• Imanie Marie Forest, RN

• Massage Therapist in Olympia, WA
• Providers in Olympia, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.

Verify at the official NPI Registry.