Provider Demographics
NPI:1396176269
Name:LUIZ, REGINA MARIE (RN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:LUIZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7040
Mailing Address - Country:US
Mailing Address - Phone:916-453-3534
Mailing Address - Fax:916-454-2012
Practice Address - Street 1:1771 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7040
Practice Address - Country:US
Practice Address - Phone:916-453-3534
Practice Address - Fax:916-454-2012
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569472163WD1100X, 163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis