Provider Demographics
NPI:1053020131
Name:RIVERA, GABRIELA MELISSA (MS)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:MELISSA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5952 AKIN PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2165
Mailing Address - Country:US
Mailing Address - Phone:210-551-6062
Mailing Address - Fax:
Practice Address - Street 1:16607 BLANCO RD STE 1102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1964
Practice Address - Country:US
Practice Address - Phone:830-255-7644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist