Provider Demographics
NPI:1003632431
Name:RODRIGUEZ LORA, GABRIEL
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:RODRIGUEZ LORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20119 THREE CHUTES LN # 77433USA
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5148
Mailing Address - Country:US
Mailing Address - Phone:346-573-5605
Mailing Address - Fax:
Practice Address - Street 1:10131 HAMMERLY BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-5014
Practice Address - Country:US
Practice Address - Phone:346-573-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2025-08-18
Deactivation Date:2025-07-02
Deactivation Code:
Reactivation Date:2025-08-18
Provider Licenses
StateLicense IDTaxonomies
NV867496163WH0200X
FL11041197363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health