Provider Demographics
NPI:1013445469
Name:FREGOSO, REINA
Entity Type:Individual
Prefix:
First Name:REINA
Middle Name:
Last Name:FREGOSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 W MIRACLE MILE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-3708
Mailing Address - Country:US
Mailing Address - Phone:520-750-9667
Mailing Address - Fax:520-750-0056
Practice Address - Street 1:2183 E CALLE SIERRA DEL MANANTIAL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-5090
Practice Address - Country:US
Practice Address - Phone:520-982-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor