Healthcare Provider Details

I. General information

NPI: 1609342963
Provider Name (Legal Business Name): GABRIELLE NICOLE DEREGLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 S MOPAC EXPY STE D400
AUSTIN TX
78749-1461
US

IV. Provider business mailing address

5700 S MOPAC EXPY STE D400
AUSTIN TX
78749-1461
US

V. Phone/Fax

Practice location:
  • Phone: 737-418-2940
  • Fax:
Mailing address:
  • Phone: 737-418-2940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2836661
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: