# JEANNETTE MARTELLO MD A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Skin Deep
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497992465
- **Authorized official:** DR. JEANNETTE YVETTE MARTELLO M.D. (PRESIDENT)
- **Authorized official phone:** (626) 403-1747

## Contact information

- **Practice address:** 701 FREMONT AVE, SOUTH PASADENA, CA 91030-2529
- **Practice address phone:** (626) 403-1747
- **Practice address fax:** (626) 403-1784
- **Mailing address:** 701 FREMONT AVE, SOUTH PASADENA, CA 91030-2529
- **Mailing address phone:** (626) 403-1747
- **Mailing address fax:** (626) 403-1784

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | G066298 | CA | Yes |

## Other

- **Enumeration date:** 01/13/2009
- **Last updated:** 02/09/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1245452424 | INDIVIDUAL PROVIDER NPI | CA |