Provider Demographics
NPI:1326548231
Name:PALOS CASTELLANOS, SELMA
Entity Type:Individual
Prefix:
First Name:SELMA
Middle Name:
Last Name:PALOS CASTELLANOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SELMA
Other - Middle Name:ASENET
Other - Last Name:PALOS CASTELLANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4413
Mailing Address - Country:US
Mailing Address - Phone:562-661-8900
Mailing Address - Fax:
Practice Address - Street 1:145 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4413
Practice Address - Country:US
Practice Address - Phone:562-661-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA1-21-52158103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst