Provider Demographics
NPI:1669087540
Name:DIAZ RIVERA, GABRIELA M
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:M
Last Name:DIAZ RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HOSPITAL FEDERICO TRILLA KM 8.3 CALLE 3, AV. 65 INFANTE
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984
Mailing Address - Country:US
Mailing Address - Phone:787-757-1800
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL UPR- FEDERICO TRILLA
Practice Address - Street 2:CARR 3 KM 8 3 AVE 65TH INFANTERIA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-743-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2024-07-11
Deactivation Date:2021-09-30
Deactivation Code:
Reactivation Date:2021-10-29
Provider Licenses
StateLicense IDTaxonomies
PR369592084P0800X
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080025421915Medicaid