Diana Tavares de Souza Bueno, MT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA103761 Issued in FL

Practice address

4400 W Sample Rd Ste 112
Coconut Creek, FL 33073-3457

Phone

(954) 914-5997

NPI assigned

Dec 22, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Medical Technician

State licenses

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

{
    "created_epoch": "1703203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1750150413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 N CYPRESS BEND DR APT 201",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330695609",
            "telephone_number": "954-914-5997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 W SAMPLE RD STE 112",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330733457",
            "telephone_number": "954-914-5997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVARES DE SOUZA BUENO",
        "first_name": "DIANA",
        "credential": "MT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-22",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA103761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Coconut Creek, FL
• Providers in Coconut Creek, FL by specialty
• Massage Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 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.

Verify at the official NPI Registry.