Provider Demographics
NPI:1508219296
Name:REGALADO, MAGALI
Entity Type:Individual
Prefix:
First Name:MAGALI
Middle Name:
Last Name:REGALADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3576 ARLINGTON AVE
Mailing Address - Street 2:SUITE 102/104
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3943
Mailing Address - Country:US
Mailing Address - Phone:951-782-9577
Mailing Address - Fax:951-782-9521
Practice Address - Street 1:3576 ARLINGTON AVE
Practice Address - Street 2:SUITE 102/104
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3943
Practice Address - Country:US
Practice Address - Phone:951-782-9577
Practice Address - Fax:951-782-9521
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1221201215101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3387Medicaid