Provider Demographics
NPI:1497381651
Name:MANALO, KIRSTEN GAYLE (PMHNP-BC, DNP)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:GAYLE
Last Name:MANALO
Suffix:
Gender:F
Credentials:PMHNP-BC, DNP
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:GAYLE
Other - Last Name:MANALO EBUENGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7055 CHARMANT DR APT 97
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122
Mailing Address - Country:US
Mailing Address - Phone:909-645-2500
Mailing Address - Fax:
Practice Address - Street 1:DEL MAR BRAIN AND TMS
Practice Address - Street 2:12264 EL CAMINO REAL #303
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:858-436-3076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA95019321363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program