Provider Demographics
NPI:1508372095
Name:SESE, REDENTOR PATROCINIO
Entity Type:Individual
Prefix:MR
First Name:REDENTOR
Middle Name:PATROCINIO
Last Name:SESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 PORT TRINITY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1227
Mailing Address - Country:US
Mailing Address - Phone:619-254-5951
Mailing Address - Fax:
Practice Address - Street 1:6915 GLENFLORA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-2945
Practice Address - Country:US
Practice Address - Phone:619-463-5757
Practice Address - Fax:619-463-5757
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA633846163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator