Active NPI
Sourigna Berna Phan
- Massage Therapist
- Corona, CA
National Provider Identifier
1972024792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 70935
- Practice address
- 800 Magnolia Ave Ste 105
Corona, CA 92879-3123 - Phone
- (951) 905-0454
- NPI assigned
- Jun 30, 2017
- Sex
- Male
- Sole proprietor
- No
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 | 70935 | CA | Primary |
Addresses
Primary practice location
800 Magnolia Ave Ste 105
Corona, CA 92879-3123
Mailing address
800 Magnolia Ave Ste 105
Corona, CA 92879-3123
Phone (951) 905-0454
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": "1498780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1972024792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 MAGNOLIA AVE STE 105",
"city": "CORONA",
"state": "CA",
"postal_code": "928793123",
"telephone_number": "951-905-0454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 MAGNOLIA AVE STE 105",
"city": "CORONA",
"state": "CA",
"postal_code": "928793123",
"telephone_number": "951-905-0454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "SOURIGNA",
"middle_name": "BERNA",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-30",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "70935",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.