Provider Demographics
NPI:1720796113
Name:TELLEZ, REGINA (LVN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 N 7TH PL
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-2418
Mailing Address - Country:US
Mailing Address - Phone:805-202-6122
Mailing Address - Fax:
Practice Address - Street 1:1506 N 7TH PL
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-2418
Practice Address - Country:US
Practice Address - Phone:805-202-6122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270997163W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No163W00000XNursing Service ProvidersRegistered Nurse