Provider Demographics
NPI:1114553302
Name:TIUMALU-PETELO, RACHEL PENELOPE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:PENELOPE
Last Name:TIUMALU-PETELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WEST SEATTLE
Mailing Address - Street 2:2600 SW HOLDEN ST
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2828
Mailing Address - Country:US
Mailing Address - Phone:206-257-6922
Mailing Address - Fax:
Practice Address - Street 1:1114 22ND ST NE # A
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-2828
Practice Address - Country:US
Practice Address - Phone:253-345-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant