Provider Demographics
NPI:1881127595
Name:TREANTAFELLES, THEODORE GEORGE (LAC)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:GEORGE
Last Name:TREANTAFELLES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:109 SAWTELLE AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-4688
Mailing Address - Country:US
Mailing Address - Phone:805-738-8988
Mailing Address - Fax:
Practice Address - Street 1:760 LAS POSAS RD STE A3
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2910
Practice Address - Country:US
Practice Address - Phone:805-738-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00123500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist