Provider Demographics
NPI:1427360973
Name:REGALA, FELIX MATTHEW (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FELIX
Middle Name:MATTHEW
Last Name:REGALA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 BLUE GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3646
Mailing Address - Country:US
Mailing Address - Phone:325-518-3196
Mailing Address - Fax:
Practice Address - Street 1:10515 BLUE GRANITE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3646
Practice Address - Country:US
Practice Address - Phone:325-518-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21020363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant