Healthcare Provider Details

I. General information

NPI: 1417386756
Provider Name (Legal Business Name): REGALADO ANGELO VALERIO JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 10/23/2021
Certification Date: 10/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23953 RUSTICO CT
VALENCIA CA
91354-1559
US

IV. Provider business mailing address

23953 RUSTICO CT
VALENCIA CA
91354-1559
US

V. Phone/Fax

Practice location:
  • Phone: 310-880-7341
  • Fax:
Mailing address:
  • Phone: 310-880-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number713419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: