Healthcare Provider Details

I. General information

NPI: 1528978491
Provider Name (Legal Business Name): TANIA CEBALLOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 NW 105TH LN
SUNRISE FL
33322-1042
US

IV. Provider business mailing address

2850 NW 105TH LN
SUNRISE FL
33322-1042
US

V. Phone/Fax

Practice location:
  • Phone: 754-224-1159
  • Fax:
Mailing address:
  • Phone: 754-224-1159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA110212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: