Healthcare Provider Details

I. General information

NPI: 1053020131
Provider Name (Legal Business Name): GABRIELA MELISSA RIVERA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16607 BLANCO RD STE 1102
SAN ANTONIO TX
78232-1964
US

IV. Provider business mailing address

5952 AKIN PL
SAN ANTONIO TX
78261-2165
US

V. Phone/Fax

Practice location:
  • Phone: 830-255-7644
  • Fax:
Mailing address:
  • Phone: 210-551-6062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: