MEDICARE: SELU NEMBANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1902782410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELU NEMBANG

Provider Business Mailing Address
First Line	:	1715 CENTRAL AVE APT 27
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-2551
Country	:	US
Telephone Number	:	510-930-9973
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 SAN PABLO AVE STE E
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2077
Country	:	US
Telephone Number	:	510-779-2334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/12/2025

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Directions to “ SELU NEMBANG ” Practice Location

Language	Start Address	Practice Location

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