Provider Demographics
NPI:1720963804
Name:GUMPAL, KRISTINE SEVILLEJA
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:SEVILLEJA
Last Name:GUMPAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 CAMINITO ESTRELLA
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7859
Mailing Address - Country:US
Mailing Address - Phone:619-888-1861
Mailing Address - Fax:
Practice Address - Street 1:4077 FIFT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7859
Practice Address - Country:US
Practice Address - Phone:858-832-2478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95342979163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse