Active NPI
Jose M. De San Juan, C.M.T.
- Massage Therapist
- Burbank, CA
National Provider Identifier
1538465125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 18450
- Practice address
- 1820 N Avon St
Burbank, CA 91505-1505 - Phone
- (818) 480-8148
- NPI assigned
- Jan 31, 2011
- Last updated
- Jan 31, 2011
- 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 | 18450 | CA | Primary |
Addresses
Primary practice location
1820 N Avon St
Burbank, CA 91505-1505
Mailing address
1820 N Avon St
Burbank, CA 91505-1505
Phone (818) 480-8148
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 |
|---|---|---|---|
| 18450 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296432000000",
"number": "1538465125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1820 N AVON ST",
"city": "BURBANK",
"state": "CA",
"postal_code": "915051505",
"telephone_number": "818-480-8148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1820 N AVON ST",
"city": "BURBANK",
"state": "CA",
"postal_code": "915051505",
"telephone_number": "818-480-8148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE SAN JUAN",
"first_name": "JOSE",
"middle_name": "M.",
"name_prefix": "Mr.",
"credential": "C.M.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-01-31",
"last_updated": "2011-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "18450",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burbank, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.