Provider Demographics
NPI:1104506427
Name:MAILANGKAY, VICTORY B (PMHNP)
Entity type:Individual
Prefix:MS
First Name:VICTORY
Middle Name:B
Last Name:MAILANGKAY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:VICTORY
Other - Middle Name:BRIGITTA PUTRI
Other - Last Name:MAILANGKAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2019 OLIVA CT
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-7515
Mailing Address - Country:US
Mailing Address - Phone:909-824-4588
Mailing Address - Fax:
Practice Address - Street 1:2019 OLIVA CT
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-7515
Practice Address - Country:US
Practice Address - Phone:909-824-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA825960163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health