Healthcare Provider Details

I. General information

NPI: 1982807152
Provider Name (Legal Business Name): ISAAC REGEV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6380 WILSHIRE BLVD SUITE 1111
LOS ANGELES CA
90048-5003
US

IV. Provider business mailing address

9100 WILSHIRE BLVD SUITE 844W
BEVERLY HILLS CA
90212
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-4544
  • Fax: 323-653-4500
Mailing address:
  • Phone: 310-550-4544
  • Fax: 310-550-4528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA40791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: