Healthcare Provider Details

I. General information

NPI: 1609466978
Provider Name (Legal Business Name): REGINA WALKER ROBERTSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE STE 201
RIVERSIDE CA
92506-0104
US

IV. Provider business mailing address

27174 FELSIC DR
MENIFEE CA
92585-2201
US

V. Phone/Fax

Practice location:
  • Phone: 951-585-1800
  • Fax: 951-585-1801
Mailing address:
  • Phone: 951-585-1800
  • Fax: 951-585-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1019227
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: