Active NPI
Marco Antonio
- Massage Therapist
- Los Angeles, CA
National Provider Identifier
1245090745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 91285
- Practice address
- 11611 San Vicente Blvd
Los Angeles, CA 90049-5106 - Phone
- (925) 476-1767
- NPI assigned
- Mar 21, 2024
- Sex
- Male
- 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 | 91285 | CA | Primary |
Addresses
Primary practice location
11611 San Vicente Blvd
Los Angeles, CA 90049-5106
Mailing address
3020 Rowena Ave Apt 102
Los Angeles, CA 90039-2081
Phone (818) 209-0336
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 |
|---|---|---|---|
| 91285 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711065600000",
"number": "1245090745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3020 ROWENA AVE APT 102",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900392081",
"telephone_number": "818-209-0336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11611 SAN VICENTE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495106",
"telephone_number": "925-476-1767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTONIO",
"first_name": "MARCO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-21",
"last_updated": "2024-03-22",
"certification_date": "2024-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "91285",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.