Individual
DIVINA GRACIA AVERILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8595 S DECATUR BLVD STE 108, LAS VEGAS, NV 89139-7006
(702) 948-1130
(702) 688-8861
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7308
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1202877
—
NV
05
—
1467504175
—
NV
01
—
7308
STATE LICENSE
NV
Enumeration date
01/16/2007
Last updated
10/14/2022
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