Provider Demographics
NPI:1558861559
Name:REGALADO, MIGUEL ALEXANDER
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ALEXANDER
Last Name:REGALADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 GOSWELL LN
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-4809
Mailing Address - Country:US
Mailing Address - Phone:832-884-5022
Mailing Address - Fax:
Practice Address - Street 1:1327 GOSWELL LN
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4809
Practice Address - Country:US
Practice Address - Phone:832-884-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant