Gavin Maddox, MASSAGE THERAPIST

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

57336 Issued in CA

Practice address

17672 Beach Blvd Ste E
Huntington Beach, CA 92647-6836

Phone

(909) 533-1614

NPI assigned

Dec 15, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1417725896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 ROSALIA DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928352256",
            "telephone_number": "909-533-1614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17672 BEACH BLVD STE E",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926476836",
            "telephone_number": "909-533-1614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDOX",
        "first_name": "GAVIN",
        "credential": "MASSAGE THERAPIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-12-15",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": "57336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Mackay
• Cleve S Mackenzie, MD
• Jorrie Stuart Mackenzie, PH.D.
• Robert M Mackie, DMD
• Abolghassem Madani, DDS
• Gilbert Diallo Madison, SUDCC III-CS
• Diana Madokoro, PHARM.D
• Madrigal Psychological Services
• Mary Grace Madrigal, PHD
• Chloe Magana

• Massage Therapist in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Massage Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.