Provider Demographics
NPI:1912976051
Name:GORBEA, MARIA H (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:H
Last Name:GORBEA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:LOS MAESTROS
Mailing Address - Street 2:508 CARLOTA MATIENZO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-646-8062
Mailing Address - Fax:
Practice Address - Street 1:EXT VILLA RICA
Practice Address - Street 2:#J12A CALLE 2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5077
Practice Address - Country:US
Practice Address - Phone:787-780-0677
Practice Address - Fax:787-749-5070
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR109152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR#U-17028Medicare UPIN