Provider Demographics
NPI:1376719443
Name:MILTON, REGINA D (MA)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:D
Last Name:MILTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:D
Other - Last Name:SCARBON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2207 S GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93725-1210
Mailing Address - Country:US
Mailing Address - Phone:559-259-6375
Mailing Address - Fax:
Practice Address - Street 1:2207 S GARDEN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-1210
Practice Address - Country:US
Practice Address - Phone:559-259-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator