Provider Demographics
NPI:1467653485
Name:REGALADO, GUILLERMO A (MFT)
Entity Type:Individual
Prefix:MR
First Name:GUILLERMO
Middle Name:A
Last Name:REGALADO
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 STONEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-1337
Mailing Address - Country:US
Mailing Address - Phone:310-251-5516
Mailing Address - Fax:
Practice Address - Street 1:23621 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5743
Practice Address - Country:US
Practice Address - Phone:310-816-5356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist