Provider Demographics
NPI:1730870213
Name:GAVRILOV, VERONIKA
Entity type:Individual
Prefix:
First Name:VERONIKA
Middle Name:
Last Name:GAVRILOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERONIKA
Other - Middle Name:
Other - Last Name:GAVRILOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:227 N CIMARRON RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-3917
Mailing Address - Country:US
Mailing Address - Phone:702-588-2422
Mailing Address - Fax:
Practice Address - Street 1:227 N CIMARRON RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-3917
Practice Address - Country:US
Practice Address - Phone:702-588-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant