Provider Demographics
NPI:1770601023
Name:PELLETIER, MARILYN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8723 ARTESIA BLVD
Mailing Address - Street 2:SPACE - 64
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6382
Mailing Address - Country:US
Mailing Address - Phone:562-634-4741
Mailing Address - Fax:
Practice Address - Street 1:6055 E WASHINGTON BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2418
Practice Address - Country:US
Practice Address - Phone:323-346-0960
Practice Address - Fax:323-346-0966
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner