=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093252306
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NENA PAGADUAN REGALADO NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2017
-----------------------------------------------------
Last Update Date | 10/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5900 COYLE AVE STE A
-----------------------------------------------------
City | CARMICHAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-330-4447
-----------------------------------------------------
Fax | 916-332-0207
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4998 MARIAH PL
-----------------------------------------------------
City | FAIR OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95628-5031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-252-4702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9229250
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9229250
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------