Provider Demographics
NPI:1255103958
Name:HIZMO, REGINA CARLA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:CARLA
Last Name:HIZMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:CARLA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3039 MACOMB ST NW APT 1A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3323
Mailing Address - Country:US
Mailing Address - Phone:919-699-2705
Mailing Address - Fax:
Practice Address - Street 1:1400 MAIN DR NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2822
Practice Address - Country:US
Practice Address - Phone:202-808-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist