Provider Demographics
NPI:1184671679
Name:GLADYS P BEMBO DPM PA
Entity Type:Organization
Organization Name:GLADYS P BEMBO DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:POBLETE
Authorized Official - Last Name:BEMBO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:956-504-1469
Mailing Address - Street 1:5700 N EXPRESSWAY
Mailing Address - Street 2:SUITE 305B
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4353
Mailing Address - Country:US
Mailing Address - Phone:956-504-1469
Mailing Address - Fax:956-504-9270
Practice Address - Street 1:5700 N EXPRESSWAY
Practice Address - Street 2:SUITE 305B
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4353
Practice Address - Country:US
Practice Address - Phone:956-504-1469
Practice Address - Fax:956-504-9270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1203213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1846438-01Medicaid
TX1846438-01Medicaid