Provider Demographics
NPI:1043727563
Name:RIVERA TORRES, GABRIEL (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:RIVERA TORRES
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 DEL PRADO BLVD S STE 303
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7222
Mailing Address - Country:US
Mailing Address - Phone:239-317-0265
Mailing Address - Fax:239-673-7681
Practice Address - Street 1:8323 NW 12TH ST STE 108
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1839
Practice Address - Country:US
Practice Address - Phone:305-400-8511
Practice Address - Fax:305-392-0184
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLARNP9289391363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1989701OtherWELLCARE
FL234827000Medicaid
FLPZYVVOtherBLUE CROSS BLUE SHIELD
FL5680859OtherCIGNA