Provider Demographics
NPI:1891585626
Name:LOPEZ SANTIAGO, GABRIEL (RD)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:LOPEZ SANTIAGO
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 SUMMER ST APT 372
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-4477
Mailing Address - Country:US
Mailing Address - Phone:757-955-6471
Mailing Address - Fax:
Practice Address - Street 1:3030 SUMMER ST APT 372
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-4477
Practice Address - Country:US
Practice Address - Phone:757-955-6471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86146061133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered