Provider Demographics
NPI:1992743645
Name:GULBRONSON, MARICELA D (MD)
Entity type:Individual
Prefix:
First Name:MARICELA
Middle Name:D
Last Name:GULBRONSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9336
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78469-9336
Mailing Address - Country:US
Mailing Address - Phone:361-694-1603
Mailing Address - Fax:361-694-6544
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-5650
Practice Address - Fax:361-694-4257
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP387208000000X
NC9900857208000000X, 2080P0006X
TXK04842080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911657Medicaid
SCQ0085NOtherS.C. MEDICAID