Healthcare Provider Details

I. General information

NPI: 1073007399
Provider Name (Legal Business Name): DAPHNE D. ARENA GONCHAROV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 S PADRE ISLAND DR STE 118
CORPUS CHRISTI TX
78412-4946
US

IV. Provider business mailing address

7121 S PADRE ISLAND DR STE 118
CORPUS CHRISTI TX
78412-4946
US

V. Phone/Fax

Practice location:
  • Phone: 361-694-6054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberT8169
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberBP10063407
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: