Provider Demographics
NPI:1598512972
Name:TREVIZO, MOSES JR (ND)
Entity type:Individual
Prefix:DR
First Name:MOSES
Middle Name:
Last Name:TREVIZO
Suffix:JR
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 SHINCKE RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-9622
Mailing Address - Country:US
Mailing Address - Phone:505-947-6437
Mailing Address - Fax:
Practice Address - Street 1:4214 SHINCKE RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-9622
Practice Address - Country:US
Practice Address - Phone:505-947-6437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT61555858175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath