Provider Demographics
NPI:1861466609
Name:DOUGLAS, REGINA JURATE (RD)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:JURATE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10471 N STARGAZER DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-8695
Mailing Address - Country:US
Mailing Address - Phone:707-812-2082
Mailing Address - Fax:
Practice Address - Street 1:10471 N STARGAZER DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-8695
Practice Address - Country:US
Practice Address - Phone:707-812-2082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R565828133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered