Provider Demographics
NPI:1225678451
Name:CONNECTIVE HEALING TOUCH LLC
Entity Type:Organization
Organization Name:CONNECTIVE HEALING TOUCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVIZO-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:900-276-7554
Mailing Address - Street 1:1030 N MOUNTAIN AVE # 155
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-2114
Mailing Address - Country:US
Mailing Address - Phone:909-276-7554
Mailing Address - Fax:
Practice Address - Street 1:9197 CENTRAL AVE STE H
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1616
Practice Address - Country:US
Practice Address - Phone:909-276-7554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty