Provider Demographics
NPI:1144340985
Name:CRONENWETH, REGINA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:CRONENWETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:WHALEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6521 YARMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6217
Mailing Address - Country:US
Mailing Address - Phone:818-462-5077
Mailing Address - Fax:
Practice Address - Street 1:14640 VICTORY BLVD
Practice Address - Street 2:#100
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1623
Practice Address - Country:US
Practice Address - Phone:818-374-6901
Practice Address - Fax:818-374-6908
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner