Healthcare Provider Details

I. General information

NPI: 1295798221
Provider Name (Legal Business Name): MARIA STELLA GAERLAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 W CHARLESTON BLVD STE 48
LAS VEGAS NV
89102-1905
US

IV. Provider business mailing address

PO BOX 28077
LAS VEGAS NV
89126-2077
US

V. Phone/Fax

Practice location:
  • Phone: 702-870-2213
  • Fax:
Mailing address:
  • Phone: 702-870-2213
  • Fax: 702-870-2214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number8282
License Number StateNV

VIII. Authorized Official

Name: DR. MARIA STELLA GAERLAN
Title or Position: OWNER
Credential: MD
Phone: 702-870-2213