Provider Demographics
NPI:1164958492
Name:REGGI, DAVID GABRIEL ANTHONY
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GABRIEL ANTHONY
Last Name:REGGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3165
Mailing Address - Country:US
Mailing Address - Phone:619-569-3556
Mailing Address - Fax:
Practice Address - Street 1:3019 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3165
Practice Address - Country:US
Practice Address - Phone:619-569-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)