Healthcare Provider Details

I. General information

NPI: 1942600036
Provider Name (Legal Business Name): MISS REGI OH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9254 MANDEVILLE BAY AVE
LAS VEGAS NV
89148-4588
US

IV. Provider business mailing address

9254 MANDEVILLE BAY AVE
LAS VEGAS NV
89148-4588
US

V. Phone/Fax

Practice location:
  • Phone: 702-480-4766
  • Fax:
Mailing address:
  • Phone: 702-480-4766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: