Provider Demographics
NPI:1770945503
Name:BURGOS COLLAZO, GABRIELA NICOLE
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:NICOLE
Last Name:BURGOS COLLAZO
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 1:13330 WELSH PONY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2165
Mailing Address - Country:US
Mailing Address - Phone:281-704-3850
Mailing Address - Fax:
Practice Address - Street 1:5730 TIMBER CREEK PLACE DR
Practice Address - Street 2:APT 404
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5314
Practice Address - Country:US
Practice Address - Phone:281-704-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR38964163W00000X
TX1129630163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse