Provider Demographics
NPI:1477798247
Name:ADONIS REGALA DDS INC
Entity Type:Organization
Organization Name:ADONIS REGALA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADONIS
Authorized Official - Middle Name:MANALO
Authorized Official - Last Name:REGALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-251-1400
Mailing Address - Street 1:1269 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2043
Mailing Address - Country:US
Mailing Address - Phone:213-251-1400
Mailing Address - Fax:213-251-2800
Practice Address - Street 1:1269 S UNION AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2043
Practice Address - Country:US
Practice Address - Phone:213-251-1400
Practice Address - Fax:213-251-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93523-01OtherDENTI-CAL
CAD43555OtherDENTI-CAL