Provider Demographics
NPI:1538428123
Name:DIMAL, SELENA DEL CASTILLO (LVN)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:DEL CASTILLO
Last Name:DIMAL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4862 WHEELHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-8520
Mailing Address - Country:US
Mailing Address - Phone:619-250-4910
Mailing Address - Fax:
Practice Address - Street 1:4862 WHEELHOUSE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-8520
Practice Address - Country:US
Practice Address - Phone:619-250-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN245971164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse