Healthcare Provider Details

I. General information

NPI: 1598863540
Provider Name (Legal Business Name): REGINA MATILLA CUENCA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REGINA MATILLA CUENCA-MALZAHN D.O.

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W LA PALMA AVE SUITE 207
ANAHEIM CA
92801-2815
US

IV. Provider business mailing address

1211 W LA PALMA AVE SUITE 207
ANAHEIM CA
92801-2815
US

V. Phone/Fax

Practice location:
  • Phone: 714-772-8282
  • Fax: 714-772-6493
Mailing address:
  • Phone: 714-772-8282
  • Fax: 714-772-6493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A8525
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A8525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: