Provider Demographics
NPI:1235780008
Name:DARVISH, REGENCY
Entity Type:Individual
Prefix:
First Name:REGENCY
Middle Name:
Last Name:DARVISH
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 1:11800 STATE HIGHWAY 96
Mailing Address - Street 2:
Mailing Address - City:HOOPA
Mailing Address - State:CA
Mailing Address - Zip Code:95546-9742
Mailing Address - Country:US
Mailing Address - Phone:530-625-5600
Mailing Address - Fax:
Practice Address - Street 1:11800 STATE HIGHWAY 96
Practice Address - Street 2:
Practice Address - City:HOOPA
Practice Address - State:CA
Practice Address - Zip Code:95546-9742
Practice Address - Country:US
Practice Address - Phone:530-625-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist