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General NPI Number Information
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NPI Number | 1114553302
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Entity Type | Individual
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Provider Name | RACHEL PENELOPE TIUMALU-PETELO
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Gender | Female
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 1114 22ND ST NE # A
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City | AUBURN
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State | WA
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Zip | 98002-2828
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Country | US
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Telephone | 253-345-0245
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Fax |
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Provider Business Mailing Address
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Address Line | WEST SEATTLE 2600 SW HOLDEN ST
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City | SEATTLE
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State | WA
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Zip | 98126-2828
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Country | US
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Telephone | 206-257-6922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1101X
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Taxonomy Name | Ophthalmic Assistant
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License Number |
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License Number State |
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