Healthcare Provider Details

I. General information

NPI: 1770601023
Provider Name (Legal Business Name): MARILYN PELLETIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 E WASHINGTON BLVD SUITE 900
COMMERCE CA
90040-2418
US

IV. Provider business mailing address

8723 ARTESIA BLVD SPACE - 64
BELLFLOWER CA
90706-6382
US

V. Phone/Fax

Practice location:
  • Phone: 323-346-0960
  • Fax: 323-346-0966
Mailing address:
  • Phone: 562-634-4741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: