Healthcare Provider Details

I. General information

NPI: 1205919792
Provider Name (Legal Business Name): GABRIELA TT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/29/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 CALLE PRINCIPAL
BARRANQUITAS PR
00794-1631
US

IV. Provider business mailing address

57 CALLE PRINCIPAL
BARRANQUITAS PR
00794-1631
US

V. Phone/Fax

Practice location:
  • Phone: 787-857-1775
  • Fax: 787-857-0775
Mailing address:
  • Phone: 787-857-1775
  • Fax: 787-857-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-0066
License Number StatePR

VIII. Authorized Official

Name: ETANISLAO RIVERA
Title or Position: PRESIDENT
Credential: RPH
Phone: 787-857-0775