Provider Demographics
NPI:1306250972
Name:GORAVANCHI, REESA STEPHANIE (MD)
Entity type:Individual
Prefix:DR
First Name:REESA
Middle Name:STEPHANIE
Last Name:GORAVANCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REESA
Other - Middle Name:STEPHANIE
Other - Last Name:CHILD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2011 PINTO LN STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4007
Mailing Address - Country:US
Mailing Address - Phone:702-382-3200
Mailing Address - Fax:702-382-3575
Practice Address - Street 1:650 S GREEN VALLEY PKWY STE 120
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-0425
Practice Address - Country:US
Practice Address - Phone:702-847-6252
Practice Address - Fax:702-847-6254
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18136207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100559246Medicaid