Provider Demographics
NPI:1619139938
Name:REGALADO, RICHARD HERNANDEZ (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HERNANDEZ
Last Name:REGALADO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CHOWCHILLA
Mailing Address - State:CA
Mailing Address - Zip Code:93610-2820
Mailing Address - Country:US
Mailing Address - Phone:559-665-0275
Mailing Address - Fax:559-665-7126
Practice Address - Street 1:129 N 5TH ST
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-2820
Practice Address - Country:US
Practice Address - Phone:559-665-0275
Practice Address - Fax:559-665-7126
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10871363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant