Provider Demographics
NPI:1922352467
Name:DE ANDRADE, REGIANE SOARES (MD)
Entity Type:Individual
Prefix:DR
First Name:REGIANE
Middle Name:SOARES
Last Name:DE ANDRADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REGIANE
Other - Middle Name:RODRIGUES
Other - Last Name:SOARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 S MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3217
Mailing Address - Country:US
Mailing Address - Phone:714-456-8888
Mailing Address - Fax:
Practice Address - Street 1:11190 WARNER AVE STE 115
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4028
Practice Address - Country:US
Practice Address - Phone:714-210-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANO. A 121499174400000X
CAA1214992085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist