Healthcare Provider Details

I. General information

NPI: 1487213393
Provider Name (Legal Business Name): ZINNIA CARLOS REGALA DDS APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 W ALAMEDA AVE STE 216
BURBANK CA
91505-4823
US

IV. Provider business mailing address

2625 W ALAMEDA AVE STE 216
BURBANK CA
91505-4823
US

V. Phone/Fax

Practice location:
  • Phone: 818-846-8564
  • Fax:
Mailing address:
  • Phone: 818-846-8564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ZINNIA CARLOS REGALA
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 818-846-8564