Provider Demographics
NPI:1821795402
Name:REBECCAH RODRIGUEZ REGNER LLC
Entity Type:Organization
Organization Name:REBECCAH RODRIGUEZ REGNER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-909-4910
Mailing Address - Street 1:2305 VISTA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-2737
Mailing Address - Country:US
Mailing Address - Phone:602-421-4204
Mailing Address - Fax:
Practice Address - Street 1:2305 VISTA GRANDE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-2737
Practice Address - Country:US
Practice Address - Phone:602-421-4204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty