Healthcare Provider Details

I. General information

NPI: 1497381651
Provider Name (Legal Business Name): KIRSTEN GAYLE MANALO PMHNP-BC, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN GAYLE MANALO EBUENGA

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 01/27/2025
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEL MAR BRAIN AND TMS 12264 EL CAMINO REAL #303
SAN DIEGO CA
92130
US

IV. Provider business mailing address

7055 CHARMANT DR APT 97
SAN DIEGO CA
92122
US

V. Phone/Fax

Practice location:
  • Phone: 858-436-3076
  • Fax:
Mailing address:
  • Phone: 909-645-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95019321
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: