Healthcare Provider Details

I. General information

NPI: 1285528794
Provider Name (Legal Business Name): HEIDI REGENASS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 E 17TH ST STE 107
SANTA ANA CA
92705-6862
US

IV. Provider business mailing address

2549 EASTBLUFF DR # 454
NEWPORT BEACH CA
92660-3500
US

V. Phone/Fax

Practice location:
  • Phone: 714-500-7714
  • Fax:
Mailing address:
  • Phone: 602-828-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HEIDI REGENASS
Title or Position: PRESIDENT / OWNER
Credential: MD
Phone: 602-828-3495