MEDICARE: CECELIA JARAMILLO

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	MT-24957	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84-4858504	OTHER	AZ	MASSAGE THERAPY

General Provider Information

NPI Number	:	1497453658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECELIA JARAMILLO

Provider Business Mailing Address
First Line	:	8122 N 33RD AVE UNIT 2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8122 N 33RD AVE UNIT 2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6121
Country	:	US
Telephone Number	:	213-713-1141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2023
Last Update Date	:	02/17/2023

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Directions to “ CECELIA JARAMILLO ” Practice Location

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