Healthcare Provider Details

I. General information

NPI: 1821318106
Provider Name (Legal Business Name): REGINA IMELDA HOJILLA DE LUNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REGINA CARIASO

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 US HIGHWAY 18
APPLE VALLEY CA
92307-2206
US

IV. Provider business mailing address

19491 CHUPAROSA RD
APPLE VALLEY CA
92307-1689
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-8873
  • Fax:
Mailing address:
  • Phone: 760-240-8108
  • Fax: 760-240-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberC53597
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberC53597
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberC53597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: