Provider Demographics
NPI:1154512945
Name:MARMOLEJO, EDDIE JR (RESPIRATORY THERAPIS)
Entity Type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:
Last Name:MARMOLEJO
Suffix:JR
Gender:M
Credentials:RESPIRATORY THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9914 BALVANERA AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5302
Mailing Address - Country:US
Mailing Address - Phone:661-588-8689
Mailing Address - Fax:
Practice Address - Street 1:9914 BALVANERA AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-5302
Practice Address - Country:US
Practice Address - Phone:661-588-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00000299227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered