Healthcare Provider Details

I. General information

NPI: 1760149678
Provider Name (Legal Business Name): MARILYN REGLOS CUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 N PARAMOUNT BLVD
LONG BEACH CA
90805-3711
US

IV. Provider business mailing address

6060 N PARAMOUNT BLVD
LONG BEACH CA
90805-3711
US

V. Phone/Fax

Practice location:
  • Phone: 562-634-9534
  • Fax:
Mailing address:
  • Phone: 562-634-9534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95438808
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number6855126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: