Healthcare Provider Details

I. General information

NPI: 1124993290
Provider Name (Legal Business Name): LILIAN ROSE BALLENTOS GUMBAN-SALDANA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24552 PACIFIC PARK DR
ALISO VIEJO CA
92656-3055
US

IV. Provider business mailing address

24552 PACIFIC PARK DR
ALISO VIEJO CA
92656-3055
US

V. Phone/Fax

Practice location:
  • Phone: 949-446-0090
  • Fax: 949-382-2949
Mailing address:
  • Phone: 949-446-0090
  • Fax: 949-382-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95267244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: