1639148596 NPI number — MARIA GABRIELA GREGORY MD

Table of content: MARIA GABRIELA GREGORY MD (NPI 1639148596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639148596 NPI number — MARIA GABRIELA GREGORY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREGORY
Provider First Name:
MARIA
Provider Middle Name:
GABRIELA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUGLIESE
Provider Other First Name:
MARIA
Provider Other Middle Name:
GABRIELA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639148596
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100744
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-2424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 S MARYLAND PKWY STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89109-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-961-7310
Provider Business Practice Location Address Fax Number:
844-231-4920
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  6444 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043402522 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38186 . This is a "UT GROUP MEDICAID PTAN" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 109125 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40610 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100503929 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS06433 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: XPY205007 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100500484 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639148596 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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