Provider Demographics
NPI:1447397609
Name:YEN, REGINA VALDERRAMA (PT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:VALDERRAMA
Last Name:YEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 TAYLOR BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2276
Mailing Address - Country:US
Mailing Address - Phone:925-246-6000
Mailing Address - Fax:
Practice Address - Street 1:395 TAYLOR BLVD STE 118
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2276
Practice Address - Country:US
Practice Address - Phone:925-246-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist