Provider Demographics
NPI:1902350432
Name:OKUN, REGIN
Entity Type:Individual
Prefix:
First Name:REGIN
Middle Name:
Last Name:OKUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-5117
Mailing Address - Country:US
Mailing Address - Phone:415-652-0182
Mailing Address - Fax:
Practice Address - Street 1:355 SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-5117
Practice Address - Country:US
Practice Address - Phone:415-652-0182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT14617283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital