Provider Demographics
NPI:1871758508
Name:WATERS, GABRIELA RIVIELLO (NP)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:RIVIELLO
Last Name:WATERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:
Other - Last Name:RIVIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:M.C. 8896
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9001
Mailing Address - Country:US
Mailing Address - Phone:619-543-3434
Mailing Address - Fax:619-543-7202
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:M.C. 8896
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-543-3434
Practice Address - Fax:619-543-7202
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13576363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care