MEDICARE: ALDO JOSEPH TARTAGLINI PH.D.

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	103TC0700X	Clinical Psychologist	2698	CO

General Provider Information

NPI Number	:	1598949117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALDO JOSEPH TARTAGLINI PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 1674
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80901-1674
Country	:	US
Telephone Number	:	719-444-7434
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 S NEVADA AVE
Second Line	:	RM. # 4203
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4027
Country	:	US
Telephone Number	:	719-444-7434
Fax Number	:

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

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	12/18/2007

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