Provider Demographics
NPI:1275672842
Name:YANGCO-GIBSON, MA.VICTORIA MALLARI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MA.VICTORIA
Middle Name:MALLARI
Last Name:YANGCO-GIBSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9260 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2022
Mailing Address - Country:US
Mailing Address - Phone:305-899-9494
Mailing Address - Fax:305-899-9494
Practice Address - Street 1:13500 SW 88TH ST
Practice Address - Street 2:SUITE 175
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1515
Practice Address - Country:US
Practice Address - Phone:305-387-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant