Provider Demographics
NPI:1053092247
Name:SEGISMAR, KRISTIN MARIE MAGPULONG
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE MAGPULONG
Last Name:SEGISMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28052 CALLE LUMINA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-7005
Mailing Address - Country:US
Mailing Address - Phone:951-595-6828
Mailing Address - Fax:
Practice Address - Street 1:28052 CALLE LUMINA
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-7005
Practice Address - Country:US
Practice Address - Phone:951-595-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95171948163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse