Vladimir Ivanovich Cernov, MASSAGE PRACTITIONER

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA 00025393 Issued in WA

Practice address

3815 N Pearl St
None
Tacoma, WA 98407-2619

Phone

(253) 761-8053

NPI assigned

Nov 2, 2010

Last updated

Nov 2, 2010By the provider in NPPES

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

Other identifiers 1

Other names 1

• Vladimir Ivanovich Cernov Professional name

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": "1288656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288656000000",
    "number": "1689974990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 N PEARL ST",
            "address_2": "NONE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984072619",
            "telephone_number": "253-761-8053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 N PEARL ST",
            "address_2": "NONE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984072619",
            "telephone_number": "253-761-8053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERNOV",
        "first_name": "VLADIMIR",
        "middle_name": "IVANOVICH",
        "credential": "MASSAGE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-02",
        "last_updated": "2010-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA 00025393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR AND INDUSTRIES",
            "identifier": "0252162",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VLADIMIR",
            "last_name": "CERNOV",
            "middle_name": "IVANOVICH",
            "credential": "VLAD'S MASSAGE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Specialist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2010; 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.