Provider Demographics
NPI:1780069724
Name:REGO, CHARLES
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:REGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 SW 56TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7165
Mailing Address - Country:US
Mailing Address - Phone:786-631-3852
Mailing Address - Fax:786-631-3847
Practice Address - Street 1:10000 SW 56TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7165
Practice Address - Country:US
Practice Address - Phone:786-631-3852
Practice Address - Fax:786-631-3847
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician