Provider Demographics
NPI:1366232126
Name:ST URBAIN ENRIQUEZ, REGINALDE
Entity type:Individual
Prefix:
First Name:REGINALDE
Middle Name:
Last Name:ST URBAIN ENRIQUEZ
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 1:317 DAYLILY DR
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-3046
Mailing Address - Country:US
Mailing Address - Phone:909-699-0691
Mailing Address - Fax:
Practice Address - Street 1:317 DAYLILY DR
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-3046
Practice Address - Country:US
Practice Address - Phone:909-699-0691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula