MEDICARE: CLEO AMELIA TETZLOFF LAC

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	171100000X	Acupuncturist	19063	CA

General Provider Information

NPI Number	:	1073198222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEO AMELIA TETZLOFF LAC

Provider Business Mailing Address
First Line	:	PO BOX 43
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92261-0043
Country	:	US
Telephone Number	:	312-684-3504
Fax Number	:

Provider Business Practice Location Address
First Line	:	73255 EL PASEO STE 8
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-4249
Country	:	US
Telephone Number	:	312-684-3504
Fax Number	:

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

Provider Enumeration Date	:	03/09/2021
Last Update Date	:	03/09/2021

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