Provider Demographics
NPI:1417177577
Name:MANGINE, REGINA M (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:MANGINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:MARIE
Other - Last Name:TODERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 E CHASE AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6305
Mailing Address - Country:US
Mailing Address - Phone:619-442-2560
Mailing Address - Fax:619-442-7836
Practice Address - Street 1:250 E CHASE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6305
Practice Address - Country:US
Practice Address - Phone:619-442-2560
Practice Address - Fax:619-442-7836
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics