MEDICARE: GABRIELA RIVIELLO WATERS NP

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	363LA2100X	Acute Care Nurse Practitioner	13576	CA

General Provider Information

NPI Number	:	1871758508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA RIVIELLO WATERS NP

Provider Business Mailing Address
First Line	:	200 W ARBOR DR
Second Line	:	M.C. 8896
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	619-543-3434
Fax Number	:	619-543-7202

Provider Business Practice Location Address
First Line	:	200 W ARBOR DR
Second Line	:	M.C. 8896
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	619-543-3434
Fax Number	:	619-543-7202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	04/08/2022

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