Provider Demographics
NPI:1992530711
Name:REGALADO, CECILIA RAMOS
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:RAMOS
Last Name:REGALADO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12626 RIVERSIDE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3473
Mailing Address - Country:US
Mailing Address - Phone:818-452-9266
Mailing Address - Fax:818-561-7638
Practice Address - Street 1:12626 RIVERSIDE DR STE 301
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3473
Practice Address - Country:US
Practice Address - Phone:818-452-9266
Practice Address - Fax:818-561-7638
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily