Provider Demographics
NPI:1164989406
Name:SILVESTRE, SELINA
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:
Last Name:SILVESTRE
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 1:101 GOLD CIR APT 2004
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4342
Mailing Address - Country:US
Mailing Address - Phone:775-813-5130
Mailing Address - Fax:
Practice Address - Street 1:101 GOLD CIR APT 2004
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4342
Practice Address - Country:US
Practice Address - Phone:775-813-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician