Healthcare Provider Details

I. General information

NPI: 1396108684
Provider Name (Legal Business Name): PBC HOSPITALIST GROUP P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2739 TREANOR TER
WELLINGTON FL
33414-6460
US

IV. Provider business mailing address

2739 TREANOR TER
WELLINGTON FL
33414-6460
US

V. Phone/Fax

Practice location:
  • Phone: 561-523-5653
  • Fax: 561-491-7152
Mailing address:
  • Phone: 561-523-5653
  • Fax: 561-491-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME80762
License Number StateFL

VIII. Authorized Official

Name: DR. CONSTANTINO LUIS REGALADO
Title or Position: OWNER
Credential: M.D.
Phone: 561-523-5653