Provider Demographics
NPI:1609683762
Name:LADRIDO, JENELLE
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:LADRIDO
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 1:3141 TIGER RUN CT STE 114
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6706
Mailing Address - Country:US
Mailing Address - Phone:760-585-2178
Mailing Address - Fax:833-409-0654
Practice Address - Street 1:3141 TIGER RUN CT STE 114
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6706
Practice Address - Country:US
Practice Address - Phone:760-585-2178
Practice Address - Fax:833-409-0654
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT307152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist