Provider Demographics
NPI:1184655508
Name:GOBENCION, MARIA P (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:P
Last Name:GOBENCION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-1337
Mailing Address - Country:US
Mailing Address - Phone:505-722-1000
Mailing Address - Fax:505-722-1650
Practice Address - Street 1:516 E. NIZHONI BLVD.
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-1337
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:505-722-1650
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205504208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000F8276Medicaid
AZ551243Medicaid
TX8HZ835Medicare ID - Type UnspecifiedHSZ006
NM000F8276Medicaid
AZ551243Medicaid
H41083Medicare UPIN
TX8HZ442Medicare ID - Type UnspecifiedHSZ003
TX8HZ890Medicare ID - Type UnspecifiedHSZ001