Provider Demographics
NPI:1083705685
Name:GABALDON, DENISE L (PAC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:L
Last Name:GABALDON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30044 N 47TH ST
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-7826
Mailing Address - Country:US
Mailing Address - Phone:480-699-7661
Mailing Address - Fax:
Practice Address - Street 1:10213 N 92ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4561
Practice Address - Country:US
Practice Address - Phone:480-860-6005
Practice Address - Fax:480-860-1882
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3053363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical