MEDICARE: MS. DIANNA MARIE ENCARNACION CMT, MMT

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	56554	CA

General Provider Information

NPI Number	:	1265945612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANNA MARIE ENCARNACION CMT, MMT

Provider Business Mailing Address
First Line	:	727 E. PALM AVE.
Second Line	:	APT. B
City	:	BURBANK
State	:	CA
Zip	:	91504-2143
Country	:	US
Telephone Number	:	818-754-7752
Fax Number	:

Provider Business Practice Location Address
First Line	:	727 E. PALM AVE.
Second Line	:	APT. B
City	:	BURBANK
State	:	CA
Zip	:	91504-2143
Country	:	US
Telephone Number	:	818-754-7752
Fax Number	:

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

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	11/08/2017

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