Healthcare Provider Details

I. General information

NPI: 1639148596
Provider Name (Legal Business Name): MARIA GABRIELA GREGORY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA GABRIELA PUGLIESE MD

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/07/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S MARYLAND PKWY STE 220
LAS VEGAS NV
89109-2424
US

IV. Provider business mailing address

PO BOX 100744
ATLANTA GA
30384-2424
US

V. Phone/Fax

Practice location:
  • Phone: 702-961-7310
  • Fax: 844-231-4920
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number6444
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: