Provider Demographics
NPI:1417846320
Name:REGALADO, JUAN (RN)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:REGALADO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7726 DERBY RUN
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3937
Mailing Address - Country:US
Mailing Address - Phone:309-533-0258
Mailing Address - Fax:
Practice Address - Street 1:7726 DERBY RUN
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-3937
Practice Address - Country:US
Practice Address - Phone:309-533-0258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1184550163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse