Provider Demographics
NPI:1699375246
Name:VALDEZ, GABRIELLE RAYMOND
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:RAYMOND
Last Name:VALDEZ
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 1:2515 CONCAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1708
Mailing Address - Country:US
Mailing Address - Phone:210-324-2248
Mailing Address - Fax:
Practice Address - Street 1:12550 LESLIE RD
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4740
Practice Address - Country:US
Practice Address - Phone:210-507-4982
Practice Address - Fax:210-507-4983
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist