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NPI Code Detail

MEDICARE: DIANE TREVOLEDES DAVIS CMT

MEDICARE: DIANE TREVOLEDES DAVIS CMT
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
1225700000XMassage Therapist68808CA

General Provider Information

NPI Number : 1154867299
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE TREVOLEDES DAVIS CMT
Provider Business Mailing Address
First Line : 2237 E ST
Second Line :
City : EUREKA
State : CA
Zip : 95501-3734
Country : US
Telephone Number : 707-268-8926
Fax Number :
Provider Business Practice Location Address
First Line : 2910 HARRIS ST
Second Line :
City : EUREKA
State : CA
Zip : 95503-4811
Country : US
Telephone Number : 707-972-0522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2017
Last Update Date : 01/12/2017

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Directions to “ DIANE TREVOLEDES DAVIS CMT” Practice Location

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