Provider Demographics
NPI:1316554058
Name:CASADEI-ZIEGLER, TRISTAN CHANTZ (CMT)
Entity Type:Individual
Prefix:MR
First Name:TRISTAN
Middle Name:CHANTZ
Last Name:CASADEI-ZIEGLER
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4086 ALAMO ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2304
Mailing Address - Country:US
Mailing Address - Phone:805-433-3811
Mailing Address - Fax:
Practice Address - Street 1:4086 ALAMO ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2304
Practice Address - Country:US
Practice Address - Phone:805-433-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83827225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist