Provider Demographics
NPI:1639148596
Name:GREGORY, MARIA GABRIELA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GABRIELA
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:GABRIELA
Other - Last Name:PUGLIESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 100744
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3201 S MARYLAND PKWY STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2424
Practice Address - Country:US
Practice Address - Phone:702-961-7310
Practice Address - Fax:844-231-4920
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV64442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1043402522Medicaid
UT38186OtherUT GROUP MEDICAID PTAN
AZ109125Medicaid
UT40610Medicaid
NV100503929Medicaid
NVCS06433OtherPHARMACY LICENSE
CAXPY205007Medicaid
NV100500484Medicaid
NV1639148596Medicaid
NV1639148596Medicaid
NV1639148596Medicaid
NVCR349ZMedicare PIN
AZ109125Medicaid
NV100503929Medicaid
NVCS06433OtherPHARMACY LICENSE
UT38186OtherUT GROUP MEDICAID PTAN
UT40610Medicaid