Provider Demographics
NPI:1093138521
Name:RIVERA, GABRIELLA (LAC)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 ELM ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1254
Mailing Address - Country:US
Mailing Address - Phone:303-903-2270
Mailing Address - Fax:
Practice Address - Street 1:1780 S BELLAIRE ST
Practice Address - Street 2:SUITE 605
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4307
Practice Address - Country:US
Practice Address - Phone:303-903-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002079171100000X
CA15594171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist