Provider Demographics
NPI:1760144133
Name:REGIS, MELITA DENNIS
Entity Type:Individual
Prefix:
First Name:MELITA
Middle Name:DENNIS
Last Name:REGIS
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 1:13717 FRANCISQUITO AVENUE
Mailing Address - Street 2:BALDWIN PARK
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:91706
Mailing Address - Country:US
Mailing Address - Phone:626-806-0792
Mailing Address - Fax:
Practice Address - Street 1:13717 FRANCISQUITO AVENUE
Practice Address - Street 2:BALDWIN PARK
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:91706
Practice Address - Country:US
Practice Address - Phone:626-806-0792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care