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General NPI Number Information
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NPI Number | 1871140152
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Entity Type | Individual
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Provider Name | KAREN TREVIZO-DIAZ CAMTC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 9197 CENTRAL AVE STE H
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City | MONTCLAIR
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State | CA
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Zip | 91763-1616
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Country | US
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Telephone | 909-276-7554
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 N MOUNTAIN AVE # 155
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City | ONTARIO
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State | CA
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Zip | 91762-2114
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Country | US
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Telephone | 909-276-7554
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 32886
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License Number State | CA
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