Provider Demographics
NPI:1649664160
Name:MORINER, GAYLE (REEG T)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:MORINER
Suffix:
Gender:F
Credentials:REEG T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W HORIZON RIDGE PKWY
Mailing Address - Street 2:#1322
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4432
Mailing Address - Country:US
Mailing Address - Phone:678-536-5210
Mailing Address - Fax:
Practice Address - Street 1:9811 W CHARLESTON BLVD # 2-641
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7528
Practice Address - Country:US
Practice Address - Phone:855-864-4322
Practice Address - Fax:888-315-4512
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2641246ZE0600X, 246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
2641OtherR.EEG T.