Provider Demographics
NPI:1043663305
Name:DISTEFANO, KAMILLA RANI
Entity Type:Individual
Prefix:
First Name:KAMILLA
Middle Name:RANI
Last Name:DISTEFANO
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 1:257 NORMANDY LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1227
Mailing Address - Country:US
Mailing Address - Phone:925-516-6665
Mailing Address - Fax:888-618-0442
Practice Address - Street 1:257 NORMANDY LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-1227
Practice Address - Country:US
Practice Address - Phone:925-516-6665
Practice Address - Fax:888-618-0442
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA079200290OtherLICENSED RCFE CAREHOME