Healthcare Provider Details

I. General information

NPI: 1205013828
Provider Name (Legal Business Name): CHANTAL UBANDO GUMPAL LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E 1ST ST
SANTA ANA CA
92705-4007
US

IV. Provider business mailing address

1501 W BURNETT ST
LONG BEACH CA
90810-3320
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-3581
  • Fax: 714-542-2246
Mailing address:
  • Phone: 562-818-7108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN227574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: