Provider Demographics
NPI:1427096429
Name:GABALDON, DION ANTHONY (CRNA, DHA)
Entity type:Individual
Prefix:DR
First Name:DION
Middle Name:ANTHONY
Last Name:GABALDON
Suffix:
Gender:M
Credentials:CRNA, DHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W MONROE ST APT 2030
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1773
Mailing Address - Country:US
Mailing Address - Phone:817-217-8107
Mailing Address - Fax:
Practice Address - Street 1:800 COTTON DEPOT LN
Practice Address - Street 2:#125
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-5578
Practice Address - Country:US
Practice Address - Phone:817-217-8107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2500367500000X
TX825688367500000X
AZCRNA0598367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN5506300Medicaid
CARN5506300Medicaid