Provider Demographics
NPI:1154977569
Name:SELTUN, LISA K
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:SELTUN
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 1:1025 W BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-4810
Mailing Address - Country:US
Mailing Address - Phone:805-415-5817
Mailing Address - Fax:
Practice Address - Street 1:1025 W BEVERLY DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-4810
Practice Address - Country:US
Practice Address - Phone:805-415-5817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician