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General NPI Number Information
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NPI Number | 1730934662
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Entity Type | Individual
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Provider Name | MS. SUSAN DENISE REGANO
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Gender | Female
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 9708 CARAWAY ST
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City | LAKESIDE
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State | CA
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Zip | 92040-4272
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Country | US
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Telephone | 619-792-0581
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Fax |
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Provider Business Mailing Address
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Address Line | 9708 CARAWAY ST
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City | LAKESIDE
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State | CA
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Zip | 92040-4272
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Country | US
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Telephone | 619-792-0581
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | SLD1983
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License Number State | CA
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