Provider Demographics
NPI:1144572249
Name:TAYENGCO-MAISOG, VICTORIA SYDECO (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SYDECO
Last Name:TAYENGCO-MAISOG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:SYDECO
Other - Last Name:TAYENGCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9304 TRIESTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913
Mailing Address - Country:US
Mailing Address - Phone:239-707-4155
Mailing Address - Fax:239-415-0028
Practice Address - Street 1:9304 TRIESTE DRIVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913
Practice Address - Country:US
Practice Address - Phone:239-707-4155
Practice Address - Fax:239-415-0028
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103467208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics