Provider Demographics
NPI:1932708419
Name:MELE, MARCELO DANIEL JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:MARCELO
Middle Name:DANIEL
Last Name:MELE
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:DANNY
Other - Middle Name:
Other - Last Name:MELE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:2116 VANDERBILT LN APT I
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3042
Mailing Address - Country:US
Mailing Address - Phone:424-243-3402
Mailing Address - Fax:
Practice Address - Street 1:2116 VANDERBILT LN APT I
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3042
Practice Address - Country:US
Practice Address - Phone:424-243-3402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28592225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist