Provider Demographics
NPI:1407122443
Name:TRIVELLA, JUAN PABLO (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:PABLO
Last Name:TRIVELLA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4750 W OAKEY BLVD STE 3B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1535
Mailing Address - Country:US
Mailing Address - Phone:702-877-8330
Mailing Address - Fax:702-877-8312
Practice Address - Street 1:1655 E CACTUS AVE # 3B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7722
Practice Address - Country:US
Practice Address - Phone:702-877-8330
Practice Address - Fax:702-877-8312
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI70891207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1407122443Medicaid