Provider Demographics
NPI:1104325893
Name:REGIS, JULIETTE
Entity type:Individual
Prefix:
First Name:JULIETTE
Middle Name:
Last Name:REGIS
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 1:185 HARBOR VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5255
Mailing Address - Country:US
Mailing Address - Phone:617-291-0743
Mailing Address - Fax:
Practice Address - Street 1:185 HARBOR VIEW RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5255
Practice Address - Country:US
Practice Address - Phone:617-291-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA00000000Medicaid
00000000OtherADULT DAY CARE