Healthcare Provider Details

I. General information

NPI: 1215321344
Provider Name (Legal Business Name): STEPHANIE MAY BA, LMT, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W MANOR DR
PACIFICA CA
94044-1846
US

IV. Provider business mailing address

15 W MANOR DR
PACIFICA CA
94044-1846
US

V. Phone/Fax

Practice location:
  • Phone: 415-407-0897
  • Fax:
Mailing address:
  • Phone: 415-407-0897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number107570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: