Provider Demographics
NPI:1164788618
Name:OBMANA, GINA FORONDA (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:FORONDA
Last Name:OBMANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:OBMANA
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:846 LAKE HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5222
Mailing Address - Country:US
Mailing Address - Phone:407-767-2477
Mailing Address - Fax:
Practice Address - Street 1:1000 W BROADWAY ST STE 100
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9261
Practice Address - Country:US
Practice Address - Phone:077-672-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 122206208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014427000Medicaid