Healthcare Provider Details

I. General information

NPI: 1962494153
Provider Name (Legal Business Name): MARITA AILEEN NOGUERA OBENZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARITA OBENZA M.D.

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10956 DONNER PASS RD FL 23
TRUCKEE CA
96161-4861
US

IV. Provider business mailing address

PO BOX 840359
HOUSTON TX
77284-0359
US

V. Phone/Fax

Practice location:
  • Phone: 530-587-3523
  • Fax:
Mailing address:
  • Phone: 832-548-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN1805
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC203774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: