Provider Demographics
NPI:1669939641
Name:REGOSO, ARLLY
Entity type:Individual
Prefix:
First Name:ARLLY
Middle Name:
Last Name:REGOSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 N SWAN RD STE 180
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6301
Mailing Address - Country:US
Mailing Address - Phone:520-382-5972
Mailing Address - Fax:
Practice Address - Street 1:2830 N SWAN RD STE 180
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6301
Practice Address - Country:US
Practice Address - Phone:520-382-5972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2020-11-09
Deactivation Date:2019-04-21
Deactivation Code:
Reactivation Date:2019-05-14
Provider Licenses
StateLicense IDTaxonomies
AZ224126363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty