Provider Demographics
NPI:1841563061
Name:SMITH, LISA REGALADO (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:REGALADO
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 SAN ILDEFONSO RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2873
Mailing Address - Country:US
Mailing Address - Phone:734-223-9955
Mailing Address - Fax:
Practice Address - Street 1:1351 SAN ILDEFONSO RD
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2873
Practice Address - Country:US
Practice Address - Phone:734-223-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-18
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2005157207SC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics