Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | G066298 | CA |
NPI | 1245452424 |
---|---|
Provider Name | Dr. Jeannette Yvette Martello |
First Address | South Pasadena, CA 91030-2529 |
Second Address | South Pasadena, CA 91030-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G066298 | MEDICAL LICENSE NUMBER (01) | CA |