Healthcare Provider Details

I. General information

NPI: 1639712599
Provider Name (Legal Business Name): ROBBIE MASANGKAY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14589 S BASCOM AVE
LOS GATOS CA
95032-2026
US

IV. Provider business mailing address

14589 S BASCOM AVE
LOS GATOS CA
95032-2026
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-7438
  • Fax:
Mailing address:
  • Phone: 408-356-7438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: