Provider Demographics
NPI:1275547150
Name:NABONG, MARIA LOUELLA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LOUELLA
Last Name:NABONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:L
Other - Last Name:MARIANO-NABONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5425 E BELL RD STE 131
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6010
Mailing Address - Country:US
Mailing Address - Phone:602-374-3396
Mailing Address - Fax:602-374-3177
Practice Address - Street 1:5425 E BELL RD STE 131
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6010
Practice Address - Country:US
Practice Address - Phone:602-374-3396
Practice Address - Fax:602-374-3177
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31582208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics