Provider Demographics
NPI:1962560722
Name:REGALA, ADONIS MANALO (DDS)
Entity type:Individual
Prefix:DR
First Name:ADONIS
Middle Name:MANALO
Last Name:REGALA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93523-01Medicare ID - Type UnspecifiedPROVIDER NUMBER