Provider Demographics
NPI:1124993290
Name:GUMBAN-SALDANA, LILIAN ROSE BALLENTOS (NP)
Entity type:Individual
Prefix:
First Name:LILIAN ROSE
Middle Name:BALLENTOS
Last Name:GUMBAN-SALDANA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24552 PACIFIC PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3055
Mailing Address - Country:US
Mailing Address - Phone:949-446-0090
Mailing Address - Fax:949-382-2949
Practice Address - Street 1:24552 PACIFIC PARK DR
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3055
Practice Address - Country:US
Practice Address - Phone:949-446-0090
Practice Address - Fax:949-382-2949
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95267244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner