Provider Demographics
NPI:1689408668
Name:MEDLINE HEALTH CLINIC INC
Entity type:Organization
Organization Name:MEDLINE HEALTH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:REGENASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:747-223-2238
Mailing Address - Street 1:8905 GLENOAKS BLVD UNIT L
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-2087
Mailing Address - Country:US
Mailing Address - Phone:747-223-2238
Mailing Address - Fax:747-223-2165
Practice Address - Street 1:8905 GLENOAKS BLVD UNIT L
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-2087
Practice Address - Country:US
Practice Address - Phone:747-223-2238
Practice Address - Fax:747-223-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty