Provider Demographics
NPI:1790824340
Name:BRITTO, REGIS J (MD)
Entity type:Individual
Prefix:
First Name:REGIS
Middle Name:J
Last Name:BRITTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 EAST ST STE 330B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1153
Mailing Address - Country:US
Mailing Address - Phone:530-241-9450
Mailing Address - Fax:530-241-5920
Practice Address - Street 1:1555 EAST ST STE 330B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1153
Practice Address - Country:US
Practice Address - Phone:530-241-9450
Practice Address - Fax:530-241-5920
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23791ZMedicaid
F09860Medicare UPIN
CAZZZ23791ZMedicaid