Provider Demographics
NPI:1851656946
Name:MANGUBAT, SCION CANLAS (NP-C)
Entity Type:Individual
Prefix:MISS
First Name:SCION
Middle Name:CANLAS
Last Name:MANGUBAT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SCION
Other - Middle Name:BANSIL
Other - Last Name:CANLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:969G EDGEWATER BLVD # 1004
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3760
Mailing Address - Country:US
Mailing Address - Phone:650-307-9898
Mailing Address - Fax:
Practice Address - Street 1:203 WILLOW ST STE 503
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-7733
Practice Address - Country:US
Practice Address - Phone:415-775-7766
Practice Address - Fax:415-775-7730
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21289363LA2200X, 363LF0000X, 363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care