MEDICARE: CRISTINA REGALADO PA-C

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	363A00000X	Physician Assistant	9448469-1206	UT

General Provider Information

NPI Number	:	1447632229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA REGALADO PA-C

Provider Business Mailing Address
First Line	:	2965 W 3500 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3602
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4252 S HIGHLAND DR STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2690
Country	:	US
Telephone Number	:	801-993-1800
Fax Number	:

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

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	12/04/2025

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