Provider Demographics
NPI:1285416453
Name:ZELEDON, MARTHA SOLEDAD
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:SOLEDAD
Last Name:ZELEDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 W ELMWOOD AVE APT E
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2224
Mailing Address - Country:US
Mailing Address - Phone:818-288-4020
Mailing Address - Fax:
Practice Address - Street 1:188 W ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2200
Practice Address - Country:US
Practice Address - Phone:818-288-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46889225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist