Provider Demographics
NPI:1174233647
Name:GATBONTON, EDGARDO BUENAFLOR JR
Entity type:Individual
Prefix:MR
First Name:EDGARDO
Middle Name:BUENAFLOR
Last Name:GATBONTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11743 NORTHPOINTE BLVD APT 1124
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-5595
Mailing Address - Country:US
Mailing Address - Phone:417-493-8715
Mailing Address - Fax:
Practice Address - Street 1:CORNER ROUTE 7 AND ROUTE 12
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020008187163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency