Selina Jade Preston, CSOM

Primary specialty

SpecialistTaxonomy code 174400000X

Practice address

16767 Bernardo Center Dr # 27384
San Diego, CA 92128-2509

Phone

(858) 848-9660

NPI assigned

Nov 12, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635724800000",
    "number": "1265034409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16767 BERNARDO CENTER DR # 27384",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921282509",
            "telephone_number": "858-848-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16767 BERNARDO CENTER DR # 27384",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921282509",
            "telephone_number": "858-848-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESTON",
        "first_name": "SELINA",
        "middle_name": "JADE",
        "credential": "CSOM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-12",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "31496",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Charles Preston III, M.D.
• Judith Lynne Thorson Preston, STUDENT
• Lawrence Milton Preston Jr., IDC
• Michele Preston
• Patricia Tracey Preston, PNP
• Gert Diederick Victor Pretorius, MD
• Kelly Allison Pretorius, NP, RN
• Alexander Nicholas Prevallet, DO
• Preventative Health for Happy Families
• Preventative Health for Happy Families Counseling Co

• Specialist in San Diego, CA
• Providers in San Diego, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.