Provider Demographics
NPI:1760432330
Name:DICANIO, MAGALY PAEZ (AP, DOM,LMT)
Entity Type:Individual
Prefix:
First Name:MAGALY
Middle Name:PAEZ
Last Name:DICANIO
Suffix:
Gender:F
Credentials:AP, DOM,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 W BUSCH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7766
Mailing Address - Country:US
Mailing Address - Phone:813-931-9311
Mailing Address - Fax:813-249-1544
Practice Address - Street 1:1323 W BUSCH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7766
Practice Address - Country:US
Practice Address - Phone:813-931-9311
Practice Address - Fax:813-249-1544
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 579171100000X
FLMA 40826225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2736OtherBLUE CROSS BLUE SHIELD
FLC0259OtherBLUE CROSS BLUE SHIELD
FLC0496OtherBLUE CROSS BLUE SHIELD