Provider Demographics
NPI:1508148438
Name:TALAVERA, GINA GABRIELA (BA)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:GABRIELA
Last Name:TALAVERA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8935 S TENAYA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-6243
Mailing Address - Country:US
Mailing Address - Phone:702-419-8018
Mailing Address - Fax:
Practice Address - Street 1:2535 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8929
Practice Address - Country:US
Practice Address - Phone:702-631-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker