Healthcare Provider Details

I. General information

NPI: 1245452424
Provider Name (Legal Business Name): JEANNETTE YVETTE MARTELLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 FREMONT AVE
SOUTH PASADENA CA
91030-2529
US

IV. Provider business mailing address

701 FREMONT AVE
SOUTH PASADENA CA
91030-2529
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-1747
  • Fax: 626-403-1784
Mailing address:
  • Phone: 626-403-1747
  • Fax: 626-403-1784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberG066298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: