MEDICARE: RACHEL PENELOPE TIUMALU-PETELO

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	156FX1101X	Ophthalmic Assistant

General Provider Information

NPI Number	:	1114553302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL PENELOPE TIUMALU-PETELO

Provider Business Mailing Address
First Line	:	WEST SEATTLE
Second Line	:	2600 SW HOLDEN ST
City	:	SEATTLE
State	:	WA
Zip	:	98126-2828
Country	:	US
Telephone Number	:	206-257-6922
Fax Number	:

Provider Business Practice Location Address
First Line	:	1114 22ND ST NE # A
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98002-2828
Country	:	US
Telephone Number	:	253-345-0245
Fax Number	:

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

Provider Enumeration Date	:	03/19/2020
Last Update Date	:	03/19/2020

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Directions to “ RACHEL PENELOPE TIUMALU-PETELO ” Practice Location

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