Provider Demographics
NPI:1801964705
Name:REGALADO, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:REGALADO
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 1:2020 ZONAL AVE
Mailing Address - Street 2:IRD 124
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-9985
Mailing Address - Country:US
Mailing Address - Phone:323-226-3691
Mailing Address - Fax:323-226-5692
Practice Address - Street 1:2020 ZONAL AVE
Practice Address - Street 2:IRD 124
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-9985
Practice Address - Country:US
Practice Address - Phone:323-226-3691
Practice Address - Fax:323-226-5692
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48168174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA165820Medicaid
CA165820Medicaid