Healthcare Provider Details

I. General information

NPI: 1376172940
Provider Name (Legal Business Name): YASEL ALMEIDA REGUEIRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 MARINER BLVD
SPRING HILL FL
34609-5603
US

IV. Provider business mailing address

4317 WATERFORD LANDING DR
LUTZ FL
33558-9727
US

V. Phone/Fax

Practice location:
  • Phone: 352-204-1254
  • Fax:
Mailing address:
  • Phone: 813-401-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN27306
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: