Provider Demographics
NPI:1922283258
Name:JEFFRIES, REGINA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12563
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-0563
Mailing Address - Country:US
Mailing Address - Phone:915-832-0890
Mailing Address - Fax:
Practice Address - Street 1:645 WALLENBERG DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5723
Practice Address - Country:US
Practice Address - Phone:915-832-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT104624174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist