Provider Demographics
NPI:1912485822
Name:RODRIGUEZ REGALADO, DINORAH (APRN)
Entity type:Individual
Prefix:
First Name:DINORAH
Middle Name:
Last Name:RODRIGUEZ REGALADO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7123 W 4TH WAY
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4961
Mailing Address - Country:US
Mailing Address - Phone:786-344-3585
Mailing Address - Fax:305-504-8813
Practice Address - Street 1:3901 NW 79TH AVE STE 256
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6554
Practice Address - Country:US
Practice Address - Phone:305-992-2421
Practice Address - Fax:305-675-4642
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9387515363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9387515OtherARNP
FL104942500Medicaid
FLLA586OtherMEDICARE PART B