Healthcare Provider Details

I. General information

NPI: 1114696796
Provider Name (Legal Business Name): REGINA ISABEL CUENCA FNP-C, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 06/28/2023
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 KNOB HILL AVE
REDONDO BEACH CA
90277-4254
US

IV. Provider business mailing address

612 KNOB HILL AVE
REDONDO BEACH CA
90277-4254
US

V. Phone/Fax

Practice location:
  • Phone: 310-409-3423
  • Fax:
Mailing address:
  • Phone: 310-409-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95018315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: