Provider Demographics
NPI:1659752707
Name:TRETTENERO, MICHELLE V (LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:V
Last Name:TRETTENERO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5168 HONPIE RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8682
Mailing Address - Country:US
Mailing Address - Phone:530-387-4975
Mailing Address - Fax:
Practice Address - Street 1:5168 HONPIE RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8682
Practice Address - Country:US
Practice Address - Phone:530-387-4975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2023-08-16
Deactivation Date:2023-07-18
Deactivation Code:
Reactivation Date:2023-08-11
Provider Licenses
StateLicense IDTaxonomies
CAAC16579171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist