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General NPI Number Information
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NPI Number | 1407122443
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Entity Type | Individual
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Provider Name | JUAN PABLO TRIVELLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 1655 E CACTUS AVE # 3B
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City | LAS VEGAS
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State | NV
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Zip | 89183-7722
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Country | US
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Telephone | 702-877-8330
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Fax | 702-877-8312
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Provider Business Mailing Address
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Address Line | 4750 W OAKEY BLVD STE 3B
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City | LAS VEGAS
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State | NV
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Zip | 89102-1535
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Country | US
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Telephone | 702-877-8330
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Fax | 702-877-8312
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 70891
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License Number State | WI
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