Provider Demographics
NPI:1073382735
Name:NGOYA, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:NGOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SW CAMPUS DR APT 65-4
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-5362
Mailing Address - Country:US
Mailing Address - Phone:206-966-0922
Mailing Address - Fax:
Practice Address - Street 1:1300 SW CAMPUS DR APT 65-4
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-5362
Practice Address - Country:US
Practice Address - Phone:206-966-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP602421543140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric