MEDICARE: REGAL MEDICAL GROUP LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1457034795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGAL MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	1500 E TROPICANA AVE STE 164
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8314
Country	:	US
Telephone Number	:	424-205-9207
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 E TROPICANA AVE STE 164
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8314
Country	:	US
Telephone Number	:	424-205-9207
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MRS. ARMI REGALA SAN AGUSTIN
Credential	:
Telephone Number	:	424-205-9207

Provider Enumeration Date	:	08/11/2023
Last Update Date	:	08/11/2023

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Directions to “REGAL MEDICAL GROUP LLC ” Practice Location

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