Provider Demographics
NPI:1962937847
Name:MARAVELIAS, JANELLE RENEE (DPM)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:RENEE
Last Name:MARAVELIAS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:RENEE
Other - Last Name:BORTOLAZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:901 CAMPUS DR STE 111
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4930
Mailing Address - Country:US
Mailing Address - Phone:650-652-7060
Mailing Address - Fax:650-652-8701
Practice Address - Street 1:901 CAMPUS DR STE 111
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4930
Practice Address - Country:US
Practice Address - Phone:650-652-7060
Practice Address - Fax:650-652-8701
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5670213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty