Active NPI
Ivan Marcano
- Massage Therapist
- Davie, FL
National Provider Identifier
1962023317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA79241
- Practice address
- 2240 SW 70TH Ave Ste D
Davie, FL 33317-7112 - Phone
- (954) 430-8000
- Fax
- (954) 212-0150
- NPI assigned
- Apr 27, 2020
- 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 | MA79241 | FL | Primary |
Addresses
Primary practice location
2240 SW 70TH Ave Ste D
Davie, FL 33317-7112
Mailing address
5252 NW 85TH Ave Apt 1005
Doral, FL 33166-5332
Phone (305) 297-9695
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 |
|---|---|---|---|
| MA79241 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587945600000",
"number": "1962023317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5252 NW 85TH AVE APT 1005",
"city": "DORAL",
"state": "FL",
"postal_code": "331665332",
"telephone_number": "305-297-9695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2240 SW 70TH AVE STE D",
"city": "DAVIE",
"state": "FL",
"postal_code": "333177112",
"telephone_number": "954-430-8000",
"fax_number": "954-212-0150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCANO",
"first_name": "IVAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-27",
"last_updated": "2020-04-27",
"certification_date": "2020-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA79241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.