Provider Demographics
NPI:1750053468
Name:MARCELO-SALCEDO, CARLO NAVARRETE
Entity type:Individual
Prefix:
First Name:CARLO
Middle Name:NAVARRETE
Last Name:MARCELO-SALCEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 MOUNT CANTARA CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7942
Mailing Address - Country:US
Mailing Address - Phone:714-767-6490
Mailing Address - Fax:
Practice Address - Street 1:5522 GRACEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-8409
Practice Address - Country:US
Practice Address - Phone:626-579-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1907224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant