Provider Demographics
NPI:1902899669
Name:GAERLAN, MARIA STELLA M (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA STELLA
Middle Name:M
Last Name:GAERLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:702-870-2214
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2014-04-11
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
NV8282208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019873Medicaid
NV8282OtherLIC #
NV8282OtherLIC #
NV002019873Medicaid