Provider Demographics
NPI:1023150703
Name:REGALA, ZINNIA CARLOS (DDS)
Entity type:Individual
Prefix:MRS
First Name:ZINNIA
Middle Name:CARLOS
Last Name:REGALA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:ZINNIA
Other - Middle Name:ASUNCION
Other - Last Name:CARLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2625 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4832
Mailing Address - Country:US
Mailing Address - Phone:818-846-8564
Mailing Address - Fax:818-846-8076
Practice Address - Street 1:2625 W ALAMEDA AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4832
Practice Address - Country:US
Practice Address - Phone:818-846-8564
Practice Address - Fax:818-846-8076
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist