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General NPI Number Information
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NPI Number | 1023606282
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Entity Type | Individual
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Provider Name | BIANCA ALEXIS REGO M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 17901 NW 5TH ST STE 201
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2810
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Country | US
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Telephone | 954-606-5439
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Fax | 954-606-5430
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Provider Business Mailing Address
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Address Line | 20030 NW 5TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3318
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Country | US
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Telephone | 954-401-9740
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA17984
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License Number State | FL
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