Individual
JOEDERICK SANTOS REGUYAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14416 HAMLIN ST, SUITE 210, VAN NUYS, CA 91401-1486
(818) 989-6248
(818) 989-6214
Mailing address
21000 BRYANT ST, UNIT # 6, CANOGA PARK, CA 91304-2851
(818) 216-6687
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN206114
CA
Other
Enumeration date
08/15/2007
Last updated
08/15/2007
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