Individual
KAMILLA RANI DISTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
257 NORMANDY LN, WALNUT CREEK, CA 94598-1227
(925) 516-6665
(888) 618-0442
Mailing address
257 NORMANDY LN, WALNUT CREEK, CA 94598-1227
(925) 516-6665
(888) 618-0442
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079200290
LICENSED RCFE CAREHOME
CA
Enumeration date
07/21/2016
Last updated
07/21/2016
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