Healthcare Provider Details

I. General information

NPI: 1093105603
Provider Name (Legal Business Name): GABRIELLA RIVERA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 E NEES AVE STE 108
FRESNO CA
93720-6012
US

IV. Provider business mailing address

3400 CALLOWAY DR STE 603
BAKERSFIELD CA
93312-2514
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-4103
  • Fax: 559-322-4104
Mailing address:
  • Phone: 661-377-1700
  • Fax: 661-616-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 42164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: