Organization
MGG AND GROUPS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY-GRACE G GAERLAN (OWNER)
(702) 434-5114
Entity
Organization
Contact information
Practice address
2255 RENAISSANCE DR STE C, LAS VEGAS, NV 89119-6751
(702) 434-5114
Mailing address
2255 RENAISSANCE DR STE C, LAS VEGAS, NV 89119-6751
(702) 434-5114
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
01/26/2018
Last updated
03/11/2020
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