Provider Demographics
NPI:1396380184
Name:SEGURA, GABRIELLE ANNALYSSE
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANNALYSSE
Last Name:SEGURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22713 LERMA CT
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-3073
Mailing Address - Country:US
Mailing Address - Phone:832-212-4551
Mailing Address - Fax:
Practice Address - Street 1:22713 LERMA CT
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-3073
Practice Address - Country:US
Practice Address - Phone:832-212-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program