Provider Demographics
NPI:1144486630
Name:GILBREATH, JULIE SOCORRO RIVERA (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:SOCORRO RIVERA
Last Name:GILBREATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:SOCORRO
Other - Last Name:RIVERA-FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 830605
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78283-0605
Mailing Address - Country:US
Mailing Address - Phone:210-222-0333
Mailing Address - Fax:210-928-4837
Practice Address - Street 1:600 DIVISION AVE STE E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-1336
Practice Address - Country:US
Practice Address - Phone:210-222-0333
Practice Address - Fax:210-928-4837
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX291576102Medicaid
TX291576102Medicaid