Healthcare Provider Details

I. General information

NPI: 1730052051
Provider Name (Legal Business Name): REINELLE MARIE DE GUZMAN REGALA RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SAN LEANDRO BLVD
SAN LEANDRO CA
94577-1595
US

IV. Provider business mailing address

5957 HILLBROOK PL
DUBLIN CA
94568-7311
US

V. Phone/Fax

Practice location:
  • Phone: 510-267-3250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95188879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: