Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant |
NPI | 1114553302 |
---|---|
Provider Name | Rachel Penelope Tiumalu-Petelo |
First Address | Seattle, WA 98126-2828 |
Second Address | Auburn, WA 98002-2828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2020 |
Last Update Date | 19/03/2020 |