Provider Demographics
NPI:1255102505
Name:RAZO, KARLA LILI (CMT)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:LILI
Last Name:RAZO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69550 HIGHWAY 111 STE 202
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2887
Mailing Address - Country:US
Mailing Address - Phone:808-865-1861
Mailing Address - Fax:
Practice Address - Street 1:69550 HIGHWAY 111 STE 202
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2887
Practice Address - Country:US
Practice Address - Phone:808-865-1861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36219225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist