Healthcare Provider Details

I. General information

NPI: 1942031729
Provider Name (Legal Business Name): IAN REGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23845 MCBEAN PKWY
VALENCIA CA
91355-2001
US

IV. Provider business mailing address

3927 SANTA CARLOTTA ST
GLENDALE CA
91214-1053
US

V. Phone/Fax

Practice location:
  • Phone: 661-200-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95181649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: