Provider Demographics
NPI:1619000189
Name:LARBIE, REGINA K
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:K
Last Name:LARBIE
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 1:5331 PIRRONE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-9089
Mailing Address - Country:US
Mailing Address - Phone:209-522-9911
Mailing Address - Fax:209-522-6611
Practice Address - Street 1:5331 PIRRONE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SALIDA
Practice Address - State:CA
Practice Address - Zip Code:95368-9089
Practice Address - Country:US
Practice Address - Phone:209-522-9911
Practice Address - Fax:209-522-6611
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5528800001Medicare NSC