Healthcare Provider Details

I. General information

NPI: 1770861775
Provider Name (Legal Business Name): MARIBEL OBENZA BREGU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18310 MONTGOMERY VILLAGE AVE STE 140
GAITHERSBURG MD
20879-3556
US

IV. Provider business mailing address

18310 MONTGOMERY VILLAGE AVE STE 140
GAITHERSBURG MD
20879-3556
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-4070
  • Fax: 301-259-5220
Mailing address:
  • Phone: 301-869-4070
  • Fax: 301-259-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2262
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: