Provider Demographics
NPI:1265477061
Name:HAITH, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:HAITH
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 1:8330 MEADOW RD STE 222
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0325
Mailing Address - Country:US
Mailing Address - Phone:214-221-8099
Mailing Address - Fax:214-221-8544
Practice Address - Street 1:8330 MEADOW RD STE 222
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-221-8099
Practice Address - Fax:214-221-8544
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX747005251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747005Medicare Oscar/Certification