Individual
DIANNE MARCELINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1227 E LOS ANGELES AVE, SIMI VALLEY, CA 93065-2871
(805) 582-4075
Mailing address
2132 RIBERA DR, OXNARD, CA 93030-5495
(805) 797-8653
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95029996
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396864351
MEDCAL
CA
01
—
1396864351
MEDICAL
—
Enumeration date
04/30/2018
Last updated
06/16/2018
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