Healthcare Provider Details

I. General information

NPI: 1689081275
Provider Name (Legal Business Name): CLAUDIA SEVILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MEDICAL CENTER CT STE 14
CHULA VISTA CA
91911-6634
US

IV. Provider business mailing address

PO BOX 845996
LOS ANGELES CA
90084-5996
US

V. Phone/Fax

Practice location:
  • Phone: 619-397-4500
  • Fax: 858-429-7931
Mailing address:
  • Phone: 858-888-7700
  • Fax: 858-221-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberA131270
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA131270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: