Provider Demographics
NPI:1669758231
Name:BANGSIL, MA. KRISTINA (RN, BSN)
Entity type:Individual
Prefix:
First Name:MA. KRISTINA
Middle Name:
Last Name:BANGSIL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2537 HARRISON CIR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2278
Mailing Address - Country:US
Mailing Address - Phone:310-953-7308
Mailing Address - Fax:
Practice Address - Street 1:2537 HARRISON CIR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2278
Practice Address - Country:US
Practice Address - Phone:310-953-7308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA805536163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA805536OtherRN LICENSE NUMBER