Provider Demographics
NPI:1265670343
Name:MARCELINO, YEDDA (DPT ATC)
Entity Type:Individual
Prefix:
First Name:YEDDA
Middle Name:
Last Name:MARCELINO
Suffix:
Gender:F
Credentials:DPT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N PROSPECT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3033
Mailing Address - Country:US
Mailing Address - Phone:310-376-9222
Mailing Address - Fax:310-376-9888
Practice Address - Street 1:520 N PROSPECT AVE STE 100
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3033
Practice Address - Country:US
Practice Address - Phone:310-376-9222
Practice Address - Fax:310-376-9888
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic