Provider Demographics
NPI:1043000284
Name:REGAN, MELINDA
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:REGAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25170 CASPARADO WAY
Mailing Address - Street 2:
Mailing Address - City:CASPAR
Mailing Address - State:CA
Mailing Address - Zip Code:95420-0191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25170 CASPARADO WAY
Practice Address - Street 2:
Practice Address - City:CASPAR
Practice Address - State:CA
Practice Address - Zip Code:95420-0191
Practice Address - Country:US
Practice Address - Phone:707-326-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95171114163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency