Provider Demographics
NPI:1245631365
Name:REGALADO, GERARDO ALBERT (FNP)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:ALBERT
Last Name:REGALADO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 W F ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3207
Mailing Address - Country:US
Mailing Address - Phone:909-988-3288
Mailing Address - Fax:909-988-6767
Practice Address - Street 1:403 W F ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3207
Practice Address - Country:US
Practice Address - Phone:909-988-3288
Practice Address - Fax:909-988-6767
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001261163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA730185OtherREGISTERED NURSE
CA95001261OtherNURSE PRACTITIONER