MEDICARE: GABRIELA MARIE RIVERA MALAVE

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	103T00000X	Psychologist	8013	PR

General Provider Information

NPI Number	:	1437981529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA MARIE RIVERA MALAVE

Provider Business Mailing Address
First Line	:	RR 2 BOX 6097-2
Second Line	:
City	:	TOA ALTA
State	:	PR
Zip	:	00953-9690
Country	:	US
Telephone Number	:	787-307-0233
Fax Number	:

Provider Business Practice Location Address
First Line	:	1226 CALLE CADIZ
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00920-3841
Country	:	US
Telephone Number	:	787-428-7939
Fax Number	:

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

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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