Provider Demographics
NPI:1780213298
Name:CLETO PENTEADO, RAFAELLA (MD)
Entity Type:Individual
Prefix:
First Name:RAFAELLA
Middle Name:
Last Name:CLETO PENTEADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9415 CAMPUS POINT DR RM 257
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0946
Mailing Address - Country:US
Mailing Address - Phone:858-534-8858
Mailing Address - Fax:858-822-0040
Practice Address - Street 1:9415 CAMPUS POINT DR RM 257
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0946
Practice Address - Country:US
Practice Address - Phone:858-534-8858
Practice Address - Fax:858-822-0040
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPTL2928207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program