MEDICARE: MRS. REGINA UY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility
2	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1033665823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REGINA UY

Provider Business Mailing Address
First Line	:	9952 BARCELONA CT
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-3044
Country	:	US
Telephone Number	:	619-339-1731
Fax Number	:

Provider Business Practice Location Address
First Line	:	8509 DALLAS ST
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-3120
Country	:	US
Telephone Number	:	619-339-1731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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