Healthcare Provider Details

I. General information

NPI: 1609856004
Provider Name (Legal Business Name): LUCIA MAGAT GREGORIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCIA DORONILA MAGAT-GREGORIO MD

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8410 W THOMAS RD STE 112
PHOENIX AZ
85037-3356
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 602-373-7048
  • Fax: 623-873-4247
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27047
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number27047
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: