Provider Demographics
NPI:1932929353
Name:SEVILLA, EMMANUEL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:SEVILLA
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 CAMINO CARMELO UNIT 121
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3389
Mailing Address - Country:US
Mailing Address - Phone:619-944-4475
Mailing Address - Fax:
Practice Address - Street 1:1259 CAMINO CARMELO UNIT 121
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3389
Practice Address - Country:US
Practice Address - Phone:619-944-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950324772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry