Individual
MARK REGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1415 VAN CLEAVE RD NW, ALBUQUERQUE, NM 87107-3437
(505) 463-1970
Mailing address
87 ANAYA RD, TIJERAS, NM 87059-8209
(505) 463-1970
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/18/2024
Last updated
03/18/2024
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