Provider Demographics
NPI:1659083608
Name:REGAN, VINCENT A (RRT, RCP)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:REGAN
Suffix:
Gender:M
Credentials:RRT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11671 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-4985
Mailing Address - Country:US
Mailing Address - Phone:319-981-6966
Mailing Address - Fax:
Practice Address - Street 1:N7, CORNER OF ROUTES N12
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ022860227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered