MEDICARE: EMMANUEL SEVILLA PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95032477	CA

General Provider Information

NPI Number	:	1932929353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL SEVILLA PMHNP-BC

Provider Business Mailing Address
First Line	:	1259 CAMINO CARMELO UNIT 121
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-3389
Country	:	US
Telephone Number	:	619-944-4475
Fax Number	:

Provider Business Practice Location Address
First Line	:	1259 CAMINO CARMELO UNIT 121
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-3389
Country	:	US
Telephone Number	:	619-944-4475
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	03/31/2026

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