Active NPI
Camilla Ballard, CMT
- Massage Therapist
- San Leandro, CA
National Provider Identifier
1871104638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 75677
- Practice address
- 63 Dutton Avenue 2
San Leandro, CA 94577-9457 - Phone
- (151) 033-3881
- NPI assigned
- Aug 13, 2020
- Last updated
- Aug 13, 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 | 75677 | CA | Primary |
Addresses
Primary practice location
63 Dutton Avenue 2
San Leandro, CA 94577-9457
Mailing address
63 Dutton Avenue 2
San Leandro, CA 94577-2895
Phone (510) 333-3881
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75677 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597276800000",
"number": "1871104638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 DUTTON AVENUE 2",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945772895",
"telephone_number": "510-333-3881",
"fax_number": "510-878-7654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "63 DUTTON AVENUE 2",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945779457",
"telephone_number": "151-033-3881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLARD",
"first_name": "CAMILLA",
"credential": "CMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-13",
"last_updated": "2020-08-13",
"certification_date": "2020-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "75677",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.