Provider Demographics
NPI:1316407380
Name:TIMBANG, REGINA FAITH (DC)
Entity Type:Individual
Prefix:
First Name:REGINA FAITH
Middle Name:
Last Name:TIMBANG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:
Other - Last Name:TIMBANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1004 N ROANNE PL
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1431 WARNER AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6444
Practice Address - Country:US
Practice Address - Phone:714-258-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34479111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation