Provider Demographics
NPI:1114696796
Name:CUENCA, REGINA ISABEL (FNP-C, MSN)
Entity Type:Individual
Prefix:
First Name:REGINA ISABEL
Middle Name:
Last Name:CUENCA
Suffix:
Gender:F
Credentials:FNP-C, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 KNOB HILL AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4254
Mailing Address - Country:US
Mailing Address - Phone:310-409-3423
Mailing Address - Fax:
Practice Address - Street 1:612 KNOB HILL AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4254
Practice Address - Country:US
Practice Address - Phone:310-409-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily