Fong Mental & Spiritual Massage Therapy, Inc.

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

62152 Issued in FL

Legal business name

FONG MENTAL & SPIRITUAL MASSAGE THERAPY, INC.

Practice address

4011 W Flagler St
Suite 406
Coral Gables, FL 33134-1643

Phone

(786) 294-0552

NPI assigned

Nov 2, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Fernando Lorenzo Dominguez, MA 62152

Title

Licensed Massage Therapist

Phone

(786) 294-0552

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1320192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320364800000",
    "number": "1669758710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4011 W FLAGLER ST",
            "address_2": "SUITE 406",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331341643",
            "telephone_number": "786-294-0552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4011 W FLAGLER ST",
            "address_2": "SUITE 406",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331341643",
            "telephone_number": "786-294-0552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FONG MENTAL & SPIRITUAL MASSAGE THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-02",
        "last_updated": "2011-11-04",
        "status": "A",
        "authorized_official_last_name": "DOMINGUEZ",
        "authorized_official_first_name": "FERNANDO",
        "authorized_official_middle_name": "LORENZO",
        "authorized_official_title_or_position": "LICENSED MASSAGE THERAPIST",
        "authorized_official_telephone_number": "786-294-0552",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA 62152"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "62152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.

Verify at the official NPI Registry.