Healthcare Provider Details

I. General information

NPI: 1205711678
Provider Name (Legal Business Name): GABRIELA NICOLE DIAZ RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. JARDINES DE CAPARRA TT 13 CALLE MARGINAL S APT 3
BAYAMON PR
00959
US

IV. Provider business mailing address

URB. JARDINES DE CAPARRA TT 13 CALLE MARGINAL S APT 3
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-601-1009
  • Fax:
Mailing address:
  • Phone: 787-601-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: