Provider Demographics
NPI:1932120557
Name:REGGIO, JAMES ARISS (N P)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ARISS
Last Name:REGGIO
Suffix:
Gender:M
Credentials:N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 EMELINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1976
Mailing Address - Country:US
Mailing Address - Phone:831-454-4971
Mailing Address - Fax:
Practice Address - Street 1:1400 EMELINE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1976
Practice Address - Country:US
Practice Address - Phone:831-454-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15581363LP0808X
CANP15581363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC 70042FOtherMEDI-CAL PROVIDER# IN SANTA CRUZ COUNTY
CAFHC 70044FOtherMEDI-CAL PROVIDER# IN SANTA CRUZ COUNTY
CAZZZ91891ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CAZZZ91892ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN
CAZZZ92069ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN