Provider Demographics
NPI:1740460278
Name:REGALADO, GEORGIA DAMILO (RN)
Entity type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:DAMILO
Last Name:REGALADO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8437 KESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-2720
Mailing Address - Country:US
Mailing Address - Phone:818-935-1210
Mailing Address - Fax:
Practice Address - Street 1:8437 KESTER AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2720
Practice Address - Country:US
Practice Address - Phone:818-935-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA704220163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse