Provider Demographics
NPI:1477532273
Name:REGAN, MAUREEN M (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:M
Last Name:REGAN
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 1:690 GUZZI LN STE C
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5292
Mailing Address - Country:US
Mailing Address - Phone:209-533-0333
Mailing Address - Fax:209-533-2749
Practice Address - Street 1:690 GUZZI LN STE C
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5292
Practice Address - Country:US
Practice Address - Phone:209-533-0333
Practice Address - Fax:209-533-2749
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG61154207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF15485Medicare UPIN
CA00G611545Medicare PIN