Provider Demographics
NPI:1932986841
Name:BOJORQUEZ, GABRIELLE DIANDRA (LMSW)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:DIANDRA
Last Name:BOJORQUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 SHARON DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7321
Mailing Address - Country:US
Mailing Address - Phone:210-819-1364
Mailing Address - Fax:
Practice Address - Street 1:219 SHARON DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7321
Practice Address - Country:US
Practice Address - Phone:210-819-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009924995104100000X
1041C0700X
TX64663104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1932986841Medicaid