Provider Demographics
NPI:1609856004
Name:GREGORIO, LUCIA MAGAT (MD)
Entity type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:MAGAT
Last Name:GREGORIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LUCIA
Other - Middle Name:DORONILA
Other - Last Name:MAGAT-GREGORIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:
Practice Address - Street 1:8410 W THOMAS RD STE 112
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3356
Practice Address - Country:US
Practice Address - Phone:602-373-7048
Practice Address - Fax:623-873-4247
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27047207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ111093OtherMEDICARE ID - TYPE UNSPECIFIED
AZ745317Medicaid
AZ745317Medicaid