Active NPI
Simon Isaac De la Rosa, LMT/CMT
- Massage Therapist
- San Antonio, TX
National Provider Identifier
1548947989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT130587
- Practice address
- 623 Hemisfair Blvd Apt 611
San Antonio, TX 78205-3354 - Phone
- (210) 889-4635
- NPI assigned
- Jun 28, 2023
- 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 84708 | CA | |
| Massage Therapist | 225700000X | MT130587 | TX | Primary |
Addresses
Primary practice location
623 Hemisfair Blvd Apt 611
San Antonio, TX 78205-3354
Mailing address
623 Hemisfair Blvd Apt 611
San Antonio, TX 78205-3354
Phone (210) 889-4635
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 |
|---|---|---|---|
| 84708 | CA | MD | Pharmacist |
| MT130587 | TX | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687910400000",
"number": "1548947989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "623 HEMISFAIR BLVD APT 611",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782053354",
"telephone_number": "210-889-4635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "623 HEMISFAIR BLVD APT 611",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782053354",
"telephone_number": "210-889-4635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE LA ROSA",
"first_name": "SIMON",
"middle_name": "ISAAC",
"credential": "LMT/CMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-28",
"last_updated": "2023-06-28",
"certification_date": "2023-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "84708",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "TX",
"license": "MT130587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.