Individual
REGINA GANTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSFA
Contact information
Practice address
28 VALLE LINDO ROAD, PERALTA, NM 87042
(505) 280-5326
(505) 848-5008
Mailing address
28 VALLE LINDO ROAD, PERALTA, NM 87042
(505) 280-5326
(505) 848-5008
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
08/11/2015
Last updated
01/13/2016
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