Provider Demographics
NPI:1295798221
Name:MARIA STELLA GAERLAN MD PC
Entity type:Organization
Organization Name:MARIA STELLA GAERLAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:STELLA
Authorized Official - Last Name:GAERLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-870-2213
Mailing Address - Street 1:PO BOX 28077
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89126-2077
Mailing Address - Country:US
Mailing Address - Phone:702-870-2213
Mailing Address - Fax:702-870-2214
Practice Address - Street 1:2810 W CHARLESTON BLVD STE 48
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1905
Practice Address - Country:US
Practice Address - Phone:702-870-2213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8282208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019873Medicaid
NV002019873Medicaid
NVG59571Medicare UPIN