Provider Demographics
NPI:1942906425
Name:GOBENCIONG, KATRINA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:GOBENCIONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MISTY GROVES CIR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8172
Mailing Address - Country:US
Mailing Address - Phone:910-398-5273
Mailing Address - Fax:
Practice Address - Street 1:3600 NW CARY PKWY STE 104
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8444
Practice Address - Country:US
Practice Address - Phone:919-319-9219
Practice Address - Fax:919-481-1716
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC0010-13796363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program