Provider Demographics
NPI:1902445885
Name:CARRIZALES, GABRIELLA R (PA-C)
Entity type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:R
Last Name:CARRIZALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GABRIELLA
Other - Middle Name:
Other - Last Name:RABAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4197 WOODLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3493
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:2520 BROADWAY ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1149
Practice Address - Country:US
Practice Address - Phone:210-541-4884
Practice Address - Fax:210-541-4900
Is Sole Proprietor?:No
Enumeration Date:2019-12-25
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13363363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX408389102OtherCSHCN
TX408389101Medicaid