Provider Demographics
NPI:1982286639
Name:FLORENCE, REGENA VICTORIA
Entity Type:Individual
Prefix:
First Name:REGENA
Middle Name:VICTORIA
Last Name:FLORENCE
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 1:7680 STOUT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3221
Mailing Address - Country:US
Mailing Address - Phone:313-334-8475
Mailing Address - Fax:888-589-8191
Practice Address - Street 1:20222 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1240
Practice Address - Country:US
Practice Address - Phone:313-334-8475
Practice Address - Fax:888-589-8191
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date: