Provider Demographics
NPI:1063018117
Name:NAVAS MITROVITCH, DEIVE ELIAS
Entity Type:Individual
Prefix:
First Name:DEIVE
Middle Name:ELIAS
Last Name:NAVAS MITROVITCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6769 GLISSANDO CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6772
Mailing Address - Country:US
Mailing Address - Phone:702-785-8138
Mailing Address - Fax:
Practice Address - Street 1:6769 GLISSANDO CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6772
Practice Address - Country:US
Practice Address - Phone:702-785-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health