Provider Demographics
NPI:1700493970
Name:BANKS, REGINA J (MSW, MA)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:J
Last Name:BANKS
Suffix:
Gender:F
Credentials:MSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 FRESNO ST STE 108
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1439
Mailing Address - Country:US
Mailing Address - Phone:559-721-2960
Mailing Address - Fax:
Practice Address - Street 1:2900 FRESNO ST STE 108
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1439
Practice Address - Country:US
Practice Address - Phone:559-721-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty