Healthcare Provider Details

I. General information

NPI: 1407122443
Provider Name (Legal Business Name): JUAN PABLO TRIVELLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 E CACTUS AVE # 3B
LAS VEGAS NV
89183-7722
US

IV. Provider business mailing address

4750 W OAKEY BLVD STE 3B
LAS VEGAS NV
89102-1535
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-8330
  • Fax: 702-877-8312
Mailing address:
  • Phone: 702-877-8330
  • Fax: 702-877-8312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number70891
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: