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General NPI Number Information
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NPI Number | 1770945503
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Entity Type | Individual
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Provider Name | GABRIELA NICOLE BURGOS COLLAZO
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Gender | Female
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 5730 TIMBER CREEK PLACE DR APT 404
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City | HOUSTON
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State | TX
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Zip | 77084-5314
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Country | US
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Telephone | 281-704-3850
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Fax |
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Provider Business Mailing Address
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Address Line | 13330 WELSH PONY
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City | SAN ANTONIO
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State | TX
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Zip | 78254-2165
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Country | US
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Telephone | 281-704-3850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 38964
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 1129630
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License Number State | TX
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