Provider Demographics
NPI:1316040298
Name:ABACAN, GLORIA CRESENCIA B
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:CRESENCIA B
Last Name:ABACAN
Suffix:
Gender:
Credentials:
Other - Prefix:DR
Other - First Name:GLORIA
Other - Middle Name:C BALDEMOR
Other - Last Name:ABACAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0719
Mailing Address - Country:US
Mailing Address - Phone:509-837-1364
Mailing Address - Fax:
Practice Address - Street 1:820 MEMORIAL ST STE 1
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-2504
Practice Address - Country:US
Practice Address - Phone:509-786-2010
Practice Address - Fax:509-788-1794
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
911019392OtherCOMMERCIAL
WA156636OtherL & I
22855OtherGROUP HEALTH
WA8265142OtherCHPW
WA2035ABOtherREGENCE
1306897681OtherNPI PROSSER MEMORIAL
WA8265142Medicaid
WA8265142Medicaid
911019392OtherCOMMERCIAL
WA8265142OtherCHPW
1306897681OtherNPI PROSSER MEMORIAL
110224134Medicare ID - Type UnspecifiedRR MEDICARE