=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083595086
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN M BAROSSO CMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2025
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2044 FILLMORE ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94115-2777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-888-8368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 MARTIN ST
-----------------------------------------------------
City | NEVADA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95959-2809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-615-7152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 13211
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------