Provider Demographics
NPI:1922055417
Name:BEMBO, GLADYS POBLETE (DPM)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:POBLETE
Last Name:BEMBO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 CENTRAL BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7535
Mailing Address - Country:US
Mailing Address - Phone:956-504-1469
Mailing Address - Fax:956-504-9270
Practice Address - Street 1:844 CENTRAL BLVD STE 170
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7535
Practice Address - Country:US
Practice Address - Phone:956-504-1469
Practice Address - Fax:956-504-9270
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1203213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127212202Medicaid
TX127212202Medicaid
U49767Medicare UPIN
8F4437Medicare PIN