Provider Demographics
NPI:1700905007
Name:FESTEJO, CAROL MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:MARIE
Last Name:FESTEJO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:CAROLINE
Other - Last Name:CABATU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:500 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5814
Mailing Address - Country:US
Mailing Address - Phone:209-558-4598
Mailing Address - Fax:209-558-4162
Practice Address - Street 1:500 N 9TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5814
Practice Address - Country:US
Practice Address - Phone:209-558-4598
Practice Address - Fax:209-558-4162
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA624555163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health