Provider Demographics
NPI:1073106670
Name:VERGEL DE DIOS, ANN MARGARET SEVILLA (DNP)
Entity Type:Individual
Prefix:
First Name:ANN MARGARET
Middle Name:SEVILLA
Last Name:VERGEL DE DIOS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
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Mailing Address - Street 1:2214 MELOGOLD WAY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-3191
Mailing Address - Country:US
Mailing Address - Phone:714-390-1336
Mailing Address - Fax:
Practice Address - Street 1:4255 CAMPUS DR STE A100
Practice Address - Street 2:#5532
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-8650
Practice Address - Country:US
Practice Address - Phone:714-869-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95016694363LA2100X
CA95049509163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency