Healthcare Provider Details

I. General information

NPI: 1043143241
Provider Name (Legal Business Name): TATIANA MARZANO CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 JAMBOREE RD STE 265
NEWPORT BEACH CA
92660-3002
US

IV. Provider business mailing address

4425 JAMBOREE RD STE 265
NEWPORT BEACH CA
92660-3002
US

V. Phone/Fax

Practice location:
  • Phone: 650-201-0746
  • Fax:
Mailing address:
  • Phone: 650-201-0746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: FABIO MARCONE MASCAGNA
Title or Position: CFO
Credential:
Phone: 650-201-0746