MEDICARE: KAREN TREVIZO-DIAZ CAMTC

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	32886	CA

General Provider Information

NPI Number	:	1871140152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN TREVIZO-DIAZ CAMTC

Provider Business Mailing Address
First Line	:	1030 N MOUNTAIN AVE # 155
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-2114
Country	:	US
Telephone Number	:	909-276-7554
Fax Number	:

Provider Business Practice Location Address
First Line	:	9197 CENTRAL AVE STE H
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-1616
Country	:	US
Telephone Number	:	909-276-7554
Fax Number	:

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

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	12/29/2025

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