Individual provider Active NPI

Regalado Angelo Valerio Jr., CRNA

  • Registered Nurse
  • Valencia, CA
National Provider Identifier
1417386756
Registry record updated Oct 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
713419 Issued in CA
Practice address
23953 Rustico CT
Valencia, CA 91354-1559
Phone
(310) 880-7341
NPI assigned
Nov 7, 2013
Last updated
Oct 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 713419 CA Primary

Addresses

Primary practice location

23953 Rustico CT
Valencia, CA 91354-1559

Mailing address

23953 Rustico CT
Valencia, CA 91354-1559
Phone (310) 880-7341

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150710002145 CA Practitioner - Certified Registered Nurse Anesthetist (Crna) 4183936602 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
713419CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Sheldon Jordan, M.D., Inc. CurrentSince May 2, 2015 Accepting new patients
Foothill Anesthesia, Inc CurrentSince May 2, 2015 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 26, 2018 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 26, 2018 Accepting new patients
Lac-Usc Past Accepting new patients

Locations

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

301 S Fair Oaks Ave
Ste 301
Pasadena, CA 91105
Phone (626) 714-7347

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

207 S Santa Anita St
Ste G16
San Gabriel, CA 91776
Phone (626) 289-2223

15243 Vanowen St
Ste 202
Van Nuys, CA 91405
Phone (818) 419-6659

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634947200000",
    "number": "1417386756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23953 RUSTICO CT",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913541559",
            "telephone_number": "310-880-7341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23953 RUSTICO CT",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913541559",
            "telephone_number": "310-880-7341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALERIO",
        "first_name": "REGALADO",
        "middle_name": "ANGELO",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-11-07",
        "last_updated": "2021-10-23",
        "certification_date": "2021-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "713419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Valencia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.