Provider Demographics
NPI:1538185632
Name:REGALADO, CARLOS A (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:REGALADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E. ZENAIDA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-1621
Mailing Address - Country:US
Mailing Address - Phone:956-424-3116
Mailing Address - Fax:956-424-3133
Practice Address - Street 1:2121 E GRIFFIN PKWY STE 1
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3072
Practice Address - Country:US
Practice Address - Phone:956-424-3116
Practice Address - Fax:956-424-3133
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8103208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ8103OtherMEDICAL LICENSE
TX061117011Medicaid
TX061117011Medicaid