Provider Demographics
NPI:1588877427
Name:YETTER, GUADALUPE (MPT)
Entity type:Individual
Prefix:MRS
First Name:GUADALUPE
Middle Name:
Last Name:YETTER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:GUADALUPE
Other - Middle Name:MARIA
Other - Last Name:VALADEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:12202 DOLAN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3642
Mailing Address - Country:US
Mailing Address - Phone:562-305-2897
Mailing Address - Fax:
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:323-226-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist