Provider Demographics
NPI:1780173930
Name:ANDERSON, REGINA DEANN
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:DEANN
Last Name:ANDERSON
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 1:2148 HOOILI LN
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-7010
Mailing Address - Country:US
Mailing Address - Phone:337-378-4655
Mailing Address - Fax:
Practice Address - Street 1:150 SUTTER ST UNIT 120
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-9004
Practice Address - Country:US
Practice Address - Phone:337-378-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician