Provider Demographics
NPI:1376591883
Name:MARVEL, SELENE E (RN)
Entity Type:Individual
Prefix:MS
First Name:SELENE
Middle Name:E
Last Name:MARVEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SELENE
Other - Middle Name:E
Other - Last Name:FARAVARDEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:858-353-2184
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-532-5800
Practice Address - Fax:619-744-2857
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9180156163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse