Healthcare Provider Details

I. General information

NPI: 1629734371
Provider Name (Legal Business Name): REGENCY PAIN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 REGENCY PKWY
MANSFIELD TX
76063-7816
US

IV. Provider business mailing address

16970 DALLAS PKWY STE 500
DALLAS TX
75248-1983
US

V. Phone/Fax

Practice location:
  • Phone: 972-248-9550
  • Fax:
Mailing address:
  • Phone: 972-248-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHERYL ZAPATA
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-914-3322