Provider Demographics
NPI:1407818149
Name:REGALADO, MARIA MONETTE SALALIMA (MD)
Entity Type:Individual
Prefix:MISS
First Name:MARIA MONETTE
Middle Name:SALALIMA
Last Name:REGALADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 452088
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0051
Mailing Address - Country:US
Mailing Address - Phone:956-717-8600
Mailing Address - Fax:956-725-8043
Practice Address - Street 1:10710 MCPHERSON RD STE 203
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6363
Practice Address - Country:US
Practice Address - Phone:956-717-8600
Practice Address - Fax:956-725-8043
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3797174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018MPOtherBLUECROSS BLUE SHIELD
TX173509401Medicaid
TXL3797OtherTEXAS LICENSE #
TX0018MPOtherBLUECROSS BLUE SHIELD
TX173509401Medicaid