Provider Demographics
NPI:1346597101
Name:FERGINS, REGINA
Entity Type:Individual
Prefix:MISS
First Name:REGINA
Middle Name:
Last Name:FERGINS
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 1:2008 W CARSON ST
Mailing Address - Street 2:102
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3242
Mailing Address - Country:US
Mailing Address - Phone:562-446-5410
Mailing Address - Fax:
Practice Address - Street 1:2008 W CARSON ST
Practice Address - Street 2:102
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3242
Practice Address - Country:US
Practice Address - Phone:562-446-5410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies