Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 3426 | NM |
Y | 225100000X | Physical Therapist | 3426 | NM |
NPI | 1033383302 |
---|---|
Provider Name | Mr. Edward Paul Regalado |
First Address | Ruidoso, NM 88355-7100 |
Second Address | Ruidoso, NM 88345-6204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 09/05/2017 |