Provider Demographics
NPI:1821209966
Name:CASTILLO, REGINA PACIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:PACIA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 EDGEHILL CT
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-6302
Mailing Address - Country:US
Mailing Address - Phone:510-352-1495
Mailing Address - Fax:510-786-4502
Practice Address - Street 1:28472 HESPERIAN BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4853
Practice Address - Country:US
Practice Address - Phone:510-786-4501
Practice Address - Fax:510-786-4502
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice