Provider Demographics
NPI:1922149764
Name:REGALADO, FERNANDO L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:L
Last Name:REGALADO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9361 SW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6523
Mailing Address - Country:US
Mailing Address - Phone:786-348-8320
Mailing Address - Fax:
Practice Address - Street 1:3225 RIVER RD
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:LA
Practice Address - Zip Code:70094-3351
Practice Address - Country:US
Practice Address - Phone:504-836-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7373103TC0700X
LA1041103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical