Provider Demographics
NPI:1144400342
Name:DR. MARIA MONETTE REGALADO M.D.
Entity Type:Organization
Organization Name:DR. MARIA MONETTE REGALADO M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:KUYKENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-717-8600
Mailing Address - Street 1:PO BOX 452088
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0051
Mailing Address - Country:US
Mailing Address - Phone:956-717-8600
Mailing Address - Fax:956-725-8043
Practice Address - Street 1:10710 MCPHERSON RD
Practice Address - Street 2:SUITE #203
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6271
Practice Address - Country:US
Practice Address - Phone:956-717-8600
Practice Address - Fax:956-725-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3797207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018MPOtherBLUECROSS BLUESHIELD
TX00880YMedicare PIN