MEDICARE: DR. IVETTE M CUMBA-GONZALEZ D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	26205	TX
2	1223G0001X	General Practice Dentistry	2064	PR

General Provider Information

NPI Number	:	1033320544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVETTE M CUMBA-GONZALEZ D.M.D.

Provider Business Mailing Address
First Line	:	1620 S PADRE ISLAND DR
Second Line	:	SUITE 250
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78416-1353
Country	:	US
Telephone Number	:	361-853-7156
Fax Number	:	361-853-7127

Provider Business Practice Location Address
First Line	:	1620 S PADRE ISLAND DR
Second Line	:	SUITE 250
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78416-1353
Country	:	US
Telephone Number	:	361-853-7156
Fax Number	:	361-853-7127

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	01/25/2026

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