Provider Demographics
NPI:1083685960
Name:GABRIELLE, CLAUDIA G (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:G
Last Name:GABRIELLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CLAUDIA
Other - Middle Name:G
Other - Last Name:TROMBLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:201 S SHADY SHORES DR UNIT 1952
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-5089
Mailing Address - Country:US
Mailing Address - Phone:469-475-6964
Mailing Address - Fax:469-375-3979
Practice Address - Street 1:500 WATERS EDGE DR APT 324
Practice Address - Street 2:
Practice Address - City:LAKE DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75065-3090
Practice Address - Country:US
Practice Address - Phone:469-475-6964
Practice Address - Fax:469-375-3979
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30212336Medicaid
NH30212336Medicaid
NHRE7094Medicare ID - Type Unspecified