Provider Demographics
NPI:1932809019
Name:SEGURA, GABRIELA GISELLE
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:GISELLE
Last Name:SEGURA
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 1:2600 FM 1764 RD STE 170
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-2828
Mailing Address - Country:US
Mailing Address - Phone:214-828-8215
Mailing Address - Fax:
Practice Address - Street 1:2600 FM 1764 RD STE 170
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-2828
Practice Address - Country:US
Practice Address - Phone:409-240-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty