Active NPI
Melchicedec Palacios, CMT, ACSW
- Massage Therapist
- Long Beach, CA
National Provider Identifier
1477094027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 69971
- Practice address
- 3245 Santa Fe Ave Apt 62
Long Beach, CA 90810-2414 - Phone
- (310) 617-6432
- NPI assigned
- Mar 15, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 101815 | CA | |
| Massage Therapist | 225700000X | 69971 | CA | Primary |
Addresses
Primary practice location
3245 Santa Fe Ave Apt 62
Long Beach, CA 90810-2414
Mailing address
901 N Pacific Coast Hwy
Suite 200a
Redondo Beach, CA 90277-2162
Phone (310) 316-1610
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 |
|---|---|---|---|
| 101815 | CA | MD | Clinical Social Worker |
| 69971 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683763200000",
"number": "1477094027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 N PACIFIC COAST HWY",
"address_2": "SUITE 200A",
"city": "REDONDO BEACH",
"state": "CA",
"postal_code": "902772162",
"telephone_number": "310-316-1610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3245 SANTA FE AVE APT 62",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908102414",
"telephone_number": "310-617-6432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALACIOS",
"first_name": "MELCHICEDEC",
"credential": "CMT, ACSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-15",
"last_updated": "2023-05-11",
"certification_date": "2023-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "101815",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "69971",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.