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General NPI Number Information
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NPI Number | 1265670343
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Entity Type | Individual
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Provider Name | YEDDA GAN MARCELINO TONELLI DPT ATC
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Gender | Female
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 520 N PROSPECT AVE STE 100
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3033
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Country | US
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Telephone | 310-376-9222
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Fax | 310-376-9888
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Provider Business Mailing Address
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Address Line | 1908 GRANT AVE UNIT E
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City | REDONDO BEACH
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State | CA
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Zip | 90278-3527
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Country | US
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Telephone | 805-796-7084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 34824
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License Number State | CA
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