MEDICARE: GABRIELA TT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	3336C0003X	Community/Retail Pharmacy	07-F-0066	PR

General Provider Information

NPI Number	:	1205919792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GABRIELA TT LLC

Provider Business Mailing Address
First Line	:	57 CALLE PRINCIPAL
Second Line	:
City	:	BARRANQUITAS
State	:	PR
Zip	:	00794-1631
Country	:	US
Telephone Number	:	787-857-1775
Fax Number	:	787-857-0775

Provider Business Practice Location Address
First Line	:	57 CALLE PRINCIPAL
Second Line	:
City	:	BARRANQUITAS
State	:	PR
Zip	:	00794-1631
Country	:	US
Telephone Number	:	787-857-1775
Fax Number	:	787-857-0775

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ETANISLAO RIVERA
Credential	:	RPH
Telephone Number	:	787-857-0775

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	03/29/2025

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Directions to “GABRIELA TT LLC ” Practice Location

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