Mary Joan Brackin, HEALTH COACH

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

License

NONE Issued in CA

Practice address

11631 Cohansey Rd
San Diego, CA 92131-3617

Phone

(161) 984-0603

NPI assigned

Oct 27, 2021

Sex

Female

Sole proprietor

No

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

Practice roles

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.

• Thrive After Corporate

  • Student in an Organized Health Care Education/Training Program
  • Carlsbad, CA
  • NPI 1669984662
  NPD Authorized official

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

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1801550652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11631 COHANSEY RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921313617",
            "telephone_number": "161-984-0603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11631 COHANSEY RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921313617",
            "telephone_number": "161-984-0603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKIN",
        "first_name": "MARY",
        "middle_name": "JOAN",
        "name_prefix": "Ms.",
        "credential": "HEALTH COACH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-27",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "CA",
            "license": "NONE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "info@thriveaftercorporate.com",
            "affiliation": "N",
            "endpointDescription": "business email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "receiving patient information",
            "address_1": "11631 Cohansey Rd",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921313617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jesus Sandro Bracamontes Barragan, LVN
• Judy Evelyn Bracamontes
• Jennifer Elizabeth Brackett, PT, DPT
• Rachel Elizabeth Brackett, MS, OTR/L
• Samantha Lynne Brackett, MD
• Nora Villarazo Brackin, NURSE
• Douglas Brackmann, PH.D.
• Kristin Joy Reynolds Brada
• Jennie Bradach
• Suzanne Elise Bradbury, PHARM.D.07/04/1972

• Prevention Professional in San Diego, CA
• Providers in San Diego, CA by specialty
• Prevention Professional in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; 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.