Provider Demographics
NPI:1679017784
Name:CUBANGBANG, MARIA DIODONNA (MSN)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:DIODONNA
Last Name:CUBANGBANG
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 QUAMASIA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4556
Mailing Address - Country:US
Mailing Address - Phone:956-212-5841
Mailing Address - Fax:
Practice Address - Street 1:2605 QUAMASIA AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4556
Practice Address - Country:US
Practice Address - Phone:956-212-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132669363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner