MEDICARE: MAGALY PAEZ DICANIO A.P., D.O.M.,LMT

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	171100000X	Acupuncturist	AP 579	FL
2	225700000X	Massage Therapist	MA 40826	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C2736	OTHER	FL	BLUE CROSS BLUE SHIELD
2	C0259	OTHER	FL	BLUE CROSS BLUE SHIELD
3	C0496	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1760432330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGALY PAEZ DICANIO A.P., D.O.M.,LMT

Provider Business Mailing Address
First Line	:	1323 W BUSCH BLVD
Second Line	:	SUITE A
City	:	TAMPA
State	:	FL
Zip	:	33612-7766
Country	:	US
Telephone Number	:	813-931-9311
Fax Number	:	813-249-1544

Provider Business Practice Location Address
First Line	:	1323 W BUSCH BLVD
Second Line	:	SUITE A
City	:	TAMPA
State	:	FL
Zip	:	33612-7766
Country	:	US
Telephone Number	:	813-931-9311
Fax Number	:	813-249-1544

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	06/21/2010

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