Provider Demographics
NPI:1598863540
Name:CUENCA, REGINA MATILLA (DO)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:MATILLA
Last Name:CUENCA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:MATILLA
Other - Last Name:CUENCA-MALZAHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1211 W LA PALMA AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2815
Mailing Address - Country:US
Mailing Address - Phone:714-772-8282
Mailing Address - Fax:714-772-6493
Practice Address - Street 1:1211 W LA PALMA AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2815
Practice Address - Country:US
Practice Address - Phone:714-772-8282
Practice Address - Fax:714-772-6493
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8525207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00229265OtherMEDICARE RR
CA00AX85250Medicaid
CA00AX85250Medicaid
CAW20A8525AMedicare PIN
CA00AX85250Medicaid
CAP00229265OtherMEDICARE RR