Provider Demographics
NPI:1184757494
Name:REGO, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:REGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 PARK BLVD
Mailing Address - Street 2:#14
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2619
Mailing Address - Country:US
Mailing Address - Phone:619-987-8391
Mailing Address - Fax:858-270-7128
Practice Address - Street 1:4009 PARK BLVD
Practice Address - Street 2:#14
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2619
Practice Address - Country:US
Practice Address - Phone:619-987-8391
Practice Address - Fax:858-270-7128
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist