Healthcare Provider Details

I. General information

NPI: 1962946921
Provider Name (Legal Business Name): MRS. XENNIA MAE ABANGAN YGONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2016
Last Update Date: 12/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12272 W SAMPLE RD
CORAL SPRINGS FL
33065-4227
US

IV. Provider business mailing address

12272 W SAMPLE RD
CORAL SPRINGS FL
33065-4227
US

V. Phone/Fax

Practice location:
  • Phone: 954-695-4389
  • Fax:
Mailing address:
  • Phone: 954-695-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number16757
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: