Provider Demographics
NPI:1376709741
Name:GONDRA, MARIA MERCEDES (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MERCEDES
Last Name:GONDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20940 N TATUM BLVD
Mailing Address - Street 2:STE B210
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4265
Mailing Address - Country:US
Mailing Address - Phone:480-621-6331
Mailing Address - Fax:480-621-6203
Practice Address - Street 1:20940 N TATUM BLVD
Practice Address - Street 2:STE B210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4265
Practice Address - Country:US
Practice Address - Phone:480-621-6203
Practice Address - Fax:480-621-6203
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44933207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology