MEDICARE: CAMILLE GERVACIO ZELTMANN

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	133V00000X	Registered Dietitian	DT90653	TX
2	133V00000X	Registered Dietitian	86050777	NY

General Provider Information

NPI Number	:	1518523976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE GERVACIO ZELTMANN

Provider Business Mailing Address
First Line	:	3391 POPLAR ST
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-4518
Country	:	US
Telephone Number	:	917-502-2272
Fax Number	:

Provider Business Practice Location Address
First Line	:	3391 POPLAR ST
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-4518
Country	:	US
Telephone Number	:	917-502-2272
Fax Number	:

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

Provider Enumeration Date	:	05/11/2019
Last Update Date	:	08/04/2024

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