MEDICARE: M PLUS M IS ZEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	35482	CA

General Provider Information

NPI Number	:	1477976447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M PLUS M IS ZEN

Provider Business Mailing Address
First Line	:	28951 LOS ALISOS BLVD
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-5934
Country	:	US
Telephone Number	:	949-600-6272
Fax Number	:

Provider Business Practice Location Address
First Line	:	28951 LOS ALISOS BLVD
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-5934
Country	:	US
Telephone Number	:	949-600-6272
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MS. MARY ANN MARTIN
Credential	:	MASSAGE THERAPIST
Telephone Number	:	562-714-0202

Provider Enumeration Date	:	01/28/2014
Last Update Date	:	01/28/2014

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