Provider Demographics
NPI:1093167132
Name:SHAW, REGAL MIGNON (RN)
Entity Type:Individual
Prefix:
First Name:REGAL
Middle Name:MIGNON
Last Name:SHAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W CARSON ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2051
Mailing Address - Country:US
Mailing Address - Phone:310-533-9233
Mailing Address - Fax:310-533-9292
Practice Address - Street 1:1001 W CARSON ST
Practice Address - Street 2:SUITE I
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2051
Practice Address - Country:US
Practice Address - Phone:310-533-9233
Practice Address - Fax:310-533-9292
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA714688163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse