Provider Demographics
NPI:1275714719
Name:MARIA CORAZON O. REGALADO LLC
Entity Type:Organization
Organization Name:MARIA CORAZON O. REGALADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CORAZON
Authorized Official - Last Name:REGALADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-876-0350
Mailing Address - Street 1:7251 BIRKLAND CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3167
Mailing Address - Country:US
Mailing Address - Phone:702-876-0350
Mailing Address - Fax:702-876-1090
Practice Address - Street 1:3750 S JONES BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2208
Practice Address - Country:US
Practice Address - Phone:702-876-0350
Practice Address - Fax:702-847-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018265Medicaid
NVV35922Medicare PIN