Provider Demographics
NPI:1053974386
Name:MARCELO, JERWIN JAMES
Entity type:Individual
Prefix:
First Name:JERWIN
Middle Name:JAMES
Last Name:MARCELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 E 22ND ST APT 106
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-6751
Mailing Address - Country:US
Mailing Address - Phone:619-636-9128
Mailing Address - Fax:
Practice Address - Street 1:318 E 22ND ST APT 106
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-6751
Practice Address - Country:US
Practice Address - Phone:619-636-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician