MEDICARE: BRAZILIAN ZEN MASSAGE

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

General Provider Information

NPI Number	:	1588346233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAZILIAN ZEN MASSAGE

Provider Business Mailing Address
First Line	:	6559 COMLY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5401
Country	:	US
Telephone Number	:	574-276-9728
Fax Number	:

Provider Business Practice Location Address
First Line	:	7343 RONSON RD STE P
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1430
Country	:	US
Telephone Number	:	574-276-9728
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/ OWNER
Name	:	PAULO CONCEICAO
Credential	:
Telephone Number	:	574-276-9728

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	08/02/2023

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