| Doctor Name: | REGINA GANTT |
| NPI Number: | 1396121505 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CSFA |
| License Number: | |
| Business Practice Address: | 28 Valle Lindo Road Peralta, NM - 87042 |
| Business Phone Number: | 5052805326 |
| Business Fax Number: | 5058485008 |
| Mailing Address: | 28 Valle Lindo Road, PERALTA |
| State: | NM |
| Postal Code: | 87042 |
| Phone Number: | 5052805326 |
| Fax Number: | 5058485008 |
| NPI Enumeration Date: | 08/11/2015 |
| NPI Last Update Date: | 01/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |