Provider Demographics
NPI:1205919792
Name:GABRIELA TT LLC
Entity type:Organization
Organization Name:GABRIELA TT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ETANISLAO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-857-0775
Mailing Address - Street 1:57 CALLE PRINCIPAL
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1631
Mailing Address - Country:US
Mailing Address - Phone:787-857-1775
Mailing Address - Fax:787-857-0775
Practice Address - Street 1:57 CALLE PRINCIPAL
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1631
Practice Address - Country:US
Practice Address - Phone:787-857-1775
Practice Address - Fax:787-857-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
PR07-F-00663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRBF2911736OtherDEA