MEDICARE: DR. THEODORE GEORGE TREANTAFELLES L.AC.

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	25MZ00123500	NJ

General Provider Information

NPI Number	:	1881127595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE GEORGE TREANTAFELLES L.AC.

Provider Business Mailing Address
First Line	:	109 SAWTELLE AVE
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93035-4688
Country	:	US
Telephone Number	:	805-738-8988
Fax Number	:

Provider Business Practice Location Address
First Line	:	760 LAS POSAS RD STE A3
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2910
Country	:	US
Telephone Number	:	805-738-8988
Fax Number	:

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

Provider Enumeration Date	:	04/10/2017
Last Update Date	:	07/27/2021

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