Provider Demographics
NPI:1053659136
Name:REYES, REGALADO PAGTAKHAN (DC)
Entity type:Individual
Prefix:DR
First Name:REGALADO
Middle Name:PAGTAKHAN
Last Name:REYES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:REGGIE
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1101 SOUTHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-3865
Mailing Address - Country:US
Mailing Address - Phone:650-278-9127
Mailing Address - Fax:
Practice Address - Street 1:2850 SEVENTH ST STE 100
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2703
Practice Address - Country:US
Practice Address - Phone:510-845-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor