Provider Demographics
NPI:1801157789
Name:OBEDOZA, GABRIEL (IDC)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:OBEDOZA
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D MED BN, 3D MLG
Mailing Address - Street 2:UNIT #38447
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96604-8447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3D MED BN
Practice Address - Street 2:3D MLG UNIT #38447
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604-8447
Practice Address - Country:US
Practice Address - Phone:969-623-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman