Provider Demographics
NPI:1962494153
Name:OBENZA, MARITA AILEEN NOGUERA (MD)
Entity type:Individual
Prefix:DR
First Name:MARITA AILEEN
Middle Name:NOGUERA
Last Name:OBENZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARITA
Other - Middle Name:
Other - Last Name:OBENZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 840359
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77284-0359
Mailing Address - Country:US
Mailing Address - Phone:832-548-5000
Mailing Address - Fax:
Practice Address - Street 1:1344 W CLINTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-3805
Practice Address - Country:US
Practice Address - Phone:877-960-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2025-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC203774208000000X
TXN1805208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
760465919OtherTAX ID
1083861231OtherNPI