Provider Demographics
NPI:1922082924
Name:MABASA, VIRGINIA (PA)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:MABASA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:626-797-2002
Mailing Address - Fax:626-798-0567
Practice Address - Street 1:2627 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1412
Practice Address - Country:US
Practice Address - Phone:626-797-0002
Practice Address - Fax:626-798-0567
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16259363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA16259OtherLICENSE
CAWPA16259AMedicare ID - Type Unspecified
CAP67381Medicare UPIN