Healthcare Provider Details

I. General information

NPI: 1255102505
Provider Name (Legal Business Name): KARLA LILI RAZO CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69550 HIGHWAY 111 STE 202
RANCHO MIRAGE CA
92270-2887
US

IV. Provider business mailing address

69550 HIGHWAY 111 STE 202
RANCHO MIRAGE CA
92270-2887
US

V. Phone/Fax

Practice location:
  • Phone: 808-865-1861
  • Fax:
Mailing address:
  • Phone: 808-865-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number36219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: