Individual provider Active NPI

Victory B Mailangkay, PMHNP

  • Psychiatric/Mental Health Registered Nurse
  • Colton, CA
National Provider Identifier
1104506427
Registry record updated Aug 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X
License
825960 Issued in CA
Practice address
2019 Oliva CT
Colton, CA 92324-7515
Phone
(909) 824-4588
NPI assigned
Jul 21, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X 825960 CA Primary

Addresses

Primary practice location

2019 Oliva CT
Colton, CA 92324-7515

Mailing address

2019 Oliva CT
Colton, CA 92324-7515
Phone (909) 824-4588

Other names 1

  • Victory Brigitta Putri Mailangkay Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240426002827 CA Practitioner - Nurse Practitioner 9234579061 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jun R. Chiong, MD, MPH, Inc.Group PAC ID 5597925974, 12 clinicians

Practice addresses (Care Compare)

461 Tennessee St
Suite C
Redlands, CA 92373-8161
Phone (909) 475-7371

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jun R. Chiong, MD, MPH, Inc. CurrentSince Apr 1, 2024 Accepting new patients
Medex Specialty Network, Inc. CurrentSince May 17, 2024 Accepting new patients

Locations

461 Tennessee St
Ste C
Redlands, CA 92373
Phone (909) 475-7371

414 Tennessee St
Ste Xx
Redlands, CA 92373
Phone (909) 475-7371

Interoperability endpoints

  • Direct secure messaging: victory.mailangkay.1@3574.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/3574/brand/1/csg/1/fhir/r4

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1104506427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 OLIVA CT",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923247515",
            "telephone_number": "909-824-4588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2019 OLIVA CT",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923247515",
            "telephone_number": "909-824-4588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAILANGKAY",
        "first_name": "VICTORY",
        "middle_name": "B",
        "name_prefix": "Ms.",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-21",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "825960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICTORY",
            "last_name": "MAILANGKAY",
            "middle_name": "BRIGITTA PUTRI",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Colton, CA

Sources for this page

Verify at the official NPI Registry.