Provider Demographics
NPI:1669420402
Name:REGALADO, MARIA CORAZON OROZCO (MD)
Entity type:Individual
Prefix:
First Name:MARIA CORAZON
Middle Name:OROZCO
Last Name:REGALADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CORAZON
Other - Last Name:REGALADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1811 S RAINBOW BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0037
Mailing Address - Country:US
Mailing Address - Phone:702-876-0350
Mailing Address - Fax:702-847-7437
Practice Address - Street 1:1811 S RAINBOW BLVD STE 108
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-876-0350
Practice Address - Fax:702-847-7437
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8966174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018265Medicaid
NVHB017ZMedicare PIN
NVG08896Medicare UPIN