Healthcare Provider Details

I. General information

NPI: 1659704385
Provider Name (Legal Business Name): ADRINE REGANIAN RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 JUSTIN AVE 119
GLENDALE CA
91201-1801
US

IV. Provider business mailing address

1133 JUSTIN AVE 119
GLENDALE CA
91201-1801
US

V. Phone/Fax

Practice location:
  • Phone: 818-239-2259
  • Fax:
Mailing address:
  • Phone: 818-239-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: