Healthcare Provider Details

I. General information

NPI: 1669304879
Provider Name (Legal Business Name): ROBERT MATTHEW ANCIRA LMT 8419
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 AMELIA ST
NEW ORLEANS LA
70115-3625
US

IV. Provider business mailing address

5208 MAGAZINE ST # 209
NEW ORLEANS LA
70115-1846
US

V. Phone/Fax

Practice location:
  • Phone: 504-457-1717
  • Fax:
Mailing address:
  • Phone: 504-457-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA8419
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: